Job Title: Senior EDI Analyst / Business Systems Analyst
Experience: 8+ Years
Work Location: Pan India
Work Mode: Work from Office (5 days)
Project Type: Development / Support
Skill Category: EDI / Business Analysis
Job Description
We are seeking a highly skilled Senior EDI Analyst / Business Systems Analyst with extensive experience in healthcare payer systems, HIPAA X12 transactions, and integration platforms. The ideal candidate will have a strong background in end-to-end EDI workflows, production support, and seamless integration with internal systems and external trading partners.
Key Responsibilities
- Monitor and support daily EDI transaction flows (837, 835, 278, 834, 270/271) across multiple payer and provider integrations.
- Troubleshoot and resolve production issues, including edit errors, rejected files, mapping discrepancies, and reprocessing corrected X12 transactions.
- Collaborate with trading partners to validate Authorization (278) and Claims EDI workflows.
- Develop functional specifications, source-to-target mappings, data flow diagrams, and traceability documentation.
- Create job aids and process documentation for production support and new integrations.
- Participate in UAT execution, SQL validation, and post-deployment verification.
- Design and support end-to-end trading partner integrations using Cleo Cloud, EDI Fabric, and SQL-based validation.
- Lead EDI production support activities including mapping error resolution, reprocessing failed transactions, and partner testing.
- Document workflows, ICDs, and interface specifications; collaborate with QA for regression and UAT cycles.
- Deliver Medicaid and MMIS solutions through FACETS, covering Claims, Eligibility, NCPDP D.0, and Prior Authorization modules.
- Conduct JAD sessions, create BRDs/FRDs, document end-to-end process flows, and perform gap analysis.
- Validate backend data using SQL and support UAT and production rollout for claims pricing and member eligibility.
Core Competencies
- EDI & HIPAA Transactions: 837, 835, 278, 834, 270/271, SNIP validation
- Integration Engines: Cleo, Sterling, Mirth, Boomi, BizTalk
- Claims & UM Systems: FACETS, MMIS, Utilization Management workflows
- EDI Production Support: Mapping resolution, reprocessing, edits, resubmissions
- Data Analysis: SQL, relational databases (SQL Server, Oracle, MySQL, DB2)
- Documentation: BRD, FRD, ICD, data mapping, Visio workflows, job aids
- Agile Delivery: Scrum, SAFe, Kanban, backlog refinement, user story creation
- Healthcare Domain: Eligibility, provider data, claims adjudication
Technical Skills
- EDI Standards: ANSI X12 (837, 835, 834, 278, 270/271, 810, 850), HL7, NCPDP D.0
- Integration Platforms: Mirth, Boomi, BizTalk, Cleo, IBM Sterling
- Healthcare Platforms: FACETS, Epic, Cerner, Salesforce, Hansen, Edifecs
- Databases: SQL Server, Oracle, MySQL, DB2
- Tools: SQL Developer, JIRA, HP ALM, SoapUI, Visio, Lucidchart
- Reporting: Power BI, Tableau, Crystal Reports
- Methodologies: Agile/Scrum, Kanban, SAFe, Waterfall
