Healthcare Eligibility and Coverage, EDI Analyst (Remote)
Healthcare Eligibility and Coverage, EDI Analyst (Remote)
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Salary Not Disclosed
1 Vacancy
Job Description
As the EDI and Healthcare Insurance Coverage Analyst you will manage electronic data interchange (EDI) processes and ensure accurate healthcare insurance coverage verification and maintenance. You will report to Experian Health and manage new product development and operational efficiencies by streamlining data exchange between internal systems and external partners and by ensuring compliance with insurance policies and regulatory requirements.
EDI Responsibilities:
- Monitor troubleshoot and maintain EDI transactions (e.g./271 276/277)
- Collaborate with IT and external vendors to resolve EDI transmission issues
- Ensure timely and accurate data exchange between systems and trading partners
- Develop and maintain documentation for EDI processes and workflows
- Analyze EDI data for discrepancies and implement corrective actions
Insurance Discovery Responsibilities:
- Assist in the design and management of insurance coverage verification and insurance discovery technology using automated tools and manual processes
- Maintain accurate insurance information in internal systems
- Work with payers to resolve coverage issues and discrepancies
- Assist in the development of policies and procedures related to insurance verification
- Support audits and compliance initiatives related to insurance coverage
Cross-Functional Collaboration:
- Partner with Revenue Cycle IT and Compliance teams to ensure data integrity and operational alignment
- Provide training and support to staff on EDI and insurance coverage processes
Qualifications :
- Bachelors degree in Computer Sciences Healthcare Administration Information Systems Business or related field
- 3 years experience in healthcare EDI operations with an emphasis on eligibility and insurance discovery required
- 3 years experience with HIPAA data and associated transaction sets and payer requirements required
- 2 years experience with clearinghouses payer EDI and healthcare management systems (e.g. Epic Cerner or similar) required
- 3 years experience with EDI formats and standards (X12 HL7) required
- 2 years familiarity with healthcare billing and coding practices required
Additional Information :
Benefits/Perks:
- Great compensation package and bonus plan
- Core benefits including medical dental vision and matching 401K
- Flexible work environment ability to work remote
- Flexible time off including volunteer time off vacation sick and 12-paid holidays
- Explore all our exciting benefits here: Experian our people and culture set us apart. Were deeply committed to creating an environment where everyone feels they belong and can excel. From inclusion and authenticity to work/life balance development wellness collaboration and recognition we focus on what truly matters. Our people-first approach has earned us global recognition: Worlds Best Workplaces 2024 (Fortune Top 25) Great Place To Work 2025 in 26 countries and Glassdoor Best Places to Work 2024 among others.
Want to see what life at Experian is really like Explore Experian Life on social or visit our careers site.
Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay range for this position is listed above. Within this range individual pay is determined by work location and additional factors such as job-related skills experience and education. You will be also eligible for a variable pay opportunity.
Experian is proud to be an Equal Opportunity Employer for all groups protected under applicable federal state and local law including protected veterans and individuals with disabilities. Innovation is an important part of Experians DNA and practices and our inclusive workforce allows everyone to succeed and bring their whole self to work. If you have a disability or special need that requires accommodation please let us know at the earliest opportunity.
#LI-Remote
This is a remote position.
Remote Work :
Yes
Employment Type :
Full-time
Employment Type
Remote
Company Industry
Department / Functional Area
Customer Service
Key Skills
- SQL
- Information Technology
- data integrity
- Test Scripts
- AS2
- Access
- Excel
- ERP
- XML
- Troubleshoot
- Edifact
- Computer information system
- Sftp
- UNIX
