EDI Analyst
Role Overview
Foundational, hands-on role building Harbor Health's EDI operations function for health-plan enrollment and claims transactions.
Work includes day-to-day file processing, process development, automation, testing, documentation, and coordination with internal teams and external partners.
Key Skills for This Role
Full Job Posting
Position overview
Foundational, hands-on role building Harbor Health's EDI operations function for health-plan enrollment and claims transactions.
Work includes day-to-day file processing, process development, automation, testing, documentation, and coordination with internal teams and external partners.
EDI operations and issue resolution
- Process 834 enrollment files through SFTP and route them to vendors; reconcile vendor logs and monitor errors, delays, and exceptions.
- Coordinate with employer groups and HRIS vendors to correct enrollment-file errors and discrepancies.
- Implement 834 connections for new employer groups and coordinate testing, certification, test exchanges, and sign-off before go-live.
- Create and maintain companion guides and file specifications; conduct UAT on new or modified feeds before production.
- Monitor file transmission and turnaround times, review 997/999 acknowledgments and rejections, troubleshoot failures, and escalate delayed files.
- Track recurring errors and share trends to inform process or configuration fixes.
- Build and document EDI processes and identify opportunities for automation.
- Maintain current documentation and apply ASC X12 and HIPAA transaction requirements to enrollment and claims transactions.
- Coordinate with EDI vendors and clearinghouses on transmission, connectivity, and issue resolution; partner with Claims and Benefits & Configuration on downstream data accuracy.
Required experience
- 3–5 years working with 834 and 837 EDI files, with deep knowledge of their structure and segments.
- Experience with ASC X12 healthcare B2B transactions and HIPAA transaction set compliance.
- Experience testing and onboarding EDI trading partners, creating or maintaining companion guides, and conducting UAT before go-live.
- Familiarity with 997/999 acknowledgments and troubleshooting file rejections or transmission failures.
- Comfort building processes, documentation, and structure in an early-stage environment.
- Strong written and verbal communication, including coordination with employer groups, HRIS vendors, and/or EDI clearinghouses.
- Comfort using AI tools such as Claude and proprietary systems.
Related transaction sets
- The role requires working knowledge of 834 enrollment and 837 claims files.
- Familiarity with 270, 271, 278, and 835 transaction sets is to be developed as the function expands.
Workplace
- The posting identifies the position as remote in the United States.
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