Data Exchange Analyst (Healthcare EDI)

TL;DR

Data Exchange Analyst (Medical, Dental & Vision): Ensuring accurate, efficient, and secure exchange of healthcare data with partners using EDI transactions with an accent on data integration, mapping, transformation, and validation. Focus on designing mappings for 837/835 claims, 270/271 eligibility, resolving errors, monitoring feeds, and automating processes.

Location: Remote (US); onsite in New York, NY or Denver, CO

Salary: $85,000–$121,000 USD (varies by location: Remote US $85k–$100k, NY $96.8k–$121k, Denver $88.8k–$111k)

Company

Enterprise health technology company offering pharmacy benefit management, health benefit solutions, and proprietary Enterprise Health Platform for claims administration.

What you will do

• Design, develop, and maintain data mappings/transformations for EDI files (837/835 claims, 270/271 eligibility, 278 prior auth, etc.) and proprietary formats.
• Collaborate with internal teams and external partners to onboard, test, and certify new data connections.
• Implement data validation rules, resolve discrepancies/errors, and perform root cause analysis.
• Monitor data exchange systems, provide troubleshooting support, and document processes.
• Optimize/automate processes, generate performance reports, and analyze trends.
• Participate in projects like vendor changes or client migrations impacting data exchange.

Requirements

• Bachelor's in Computer Science, Information Systems, Healthcare Informatics or equivalent experience
• 2+ years in data analysis/integration/EDI in healthcare
• Knowledge of healthcare claim processes (medical, dental, vision) and EDI transactions (834, 837, 835 etc.)
• Strong EDI SNIP validations and tools like EDIFECS
• Familiarity with file protocols (FTP/SFTP/FTPS) and HIPAA compliance
• Proficiency in SQL, Excel, JSON; analytical/problem-solving skills
• Strong communication for stakeholder collaboration

Nice to have

• Experience with healthcare data feeds monitoring and automation

Culture & Benefits

• Diverse workplace with equal employment opportunities
• Flexible position allowing duty reassignment for organizational goals
• Adherence to Code of Conduct and non-compliance reporting