EDI Healthcare Analyst – Remote (US Only) || W2 Only ||

Location: Remote (US Only)
Employment Type: W2
Rate:$40/hr (No Benefits)

We are looking for experienced EDI Healthcare Analysts with strong expertise in encounter data processing EDI submission reconciliation testing and member enrollment workflows for a healthcare payer.

• Experience in encounter data processing EDI submission and reconciliation testing for a healthcare payer
• Facets REQUIRED: claims module familiarity (encounters are derived from Facets claims data); Facets-to-encounter data validation
• X12 EDI knowledge: 837P 837I 837D (Professional Institutional Dental) transaction structure loops segments
• 277CA (Claim Acknowledgement) and 999/TA1 validation
• Encounter submission & acceptance rules Medicaid Medicare Advantage TRICARE Marketplace
• Experience with Edifecs or equivalent EDI validation tooling
• SQL for encounter data validation (claim header detail member eligibility cross-checks)
• TOSCA or Robot Framework test automation
• Healthcare payer domain knowledge including CMS encounter submission rules and state-specific companion guides

• Facets REQUIRED: membership/enrollment module testing subscriber/member configuration and 834-to-Facets data flow validation
• X12 EDI: 834 (Benefit Enrollment & Maintenance) full transaction expertise
• Experience with member add/change/term dependent handling dual-enrollment scenarios
• Knowledge of retroactive adjustments and deeming logic (Medicaid/MMP/Dual)
• 820 (Premium Payment) validation linkage
• Member eligibility cross-validation (270/271 correlation)
• Enrollment reconciliation: source system vs. downstream (enrollment DB claims eligibility)
• SQL for member-level data comparisons (effective dates plan codes LOB flags)
• Experience with TOSCA or similar automation tools
• LOB knowledge: Medicaid Medicare Advantage Duals/MMP TRICARE Marketplace