To Apply for this Job Click Here
NOTE: This is a 100% remote position. Selected candidate will be working on PST Hours
**EDI Solutions Analyst
(Healthcare EDI – Claims, Billing, Eligibility, Prior Auth)**
Overview
Seeking an EDI Solutions Analyst responsible for monitoring and maintaining daily healthcare EDI transaction processing. This role ensures accurate, timely exchange of claims, billing, eligibility, remittance, and authorization data, while reducing errors and improving operational efficiency.
Key Responsibilities
- Monitor and support daily EDI transaction processing, including claims and billing transactions (EDI 837 – claims submission, EDI 835 – remittance advice).
- Troubleshoot, analyze, and resolve EDI production issues across claims, eligibility, and prior authorization workflows.
- Perform EDI testing, validation, and integration support for new implementations.
- Maintain documentation, workflow diagrams, job aids, and reporting artifacts.
- Conduct data analysis related to claims, billing, eligibility, and authorization systems.
- Prepare reports and communicate production issues to leadership.
- Collaborate with internal technical teams and external trading partners as needed.
Must-Have Technical Skills
- Strong knowledge of healthcare EDI billing and claims transactions:
EDI 837 (claims submission) and EDI 835 (remittance/billing response). - Experience with healthcare data environments (claims, eligibility, provider, payor).
- Hands-on experience with Facets or IDX.
- Proficiency in SQL for data queries, manipulation, and validation.
- Expertise in Mirth, Rhapsody, with working familiarity in BizTalk
(BizTalk exposure acceptable if strong in core healthcare EDI + integration engines). - Advanced Microsoft Excel (pivot tables, lookups, formulas) and MS Office.
Non-Technical Skills
- Clear and effective written and verbal communication.
- Strong organizational skills and attention to detail.
- Ability to solve complex data, mapping, and workflow issues independently.
Role Impact
- Reduces costly billing and claims errors, delays, and manual rework.
- Enhances patient and provider experience through accurate and timely claim processing.
- Ensures compliance with HIPAA X12 standards and partner requirements.
- Supports future migration from BizTalk to Rhapsody.
Interested candidates may submit their resumes online or call 310-906-4780 to discuss about the role.
NS-EDIO-NS_1763406442