EDI Analyst (Eligibility & Recovery)

The  EDI Analyst  will be responsible for evaluation of all healthcare related EDI X12 files along with research and comprehension of the underlying data used to generate the files. The EDI Analyst will work with the Eligibility & Recovery business to ensure accurate claim delivery and leverage experience in healthcare claims, eligibility, Coordination of Benefits (COB) or Third-Party Liability (TPL), to maximize claim acceptance rates.


Essential Duties:
• Leverage knowledge and expertise in COB/TPL/MSP to review EDI X12 files, along with the corresponding eligibility and client data.
• Review and analyze EDI X12 files, eligibility and/or client data to identify trends, patterns, and potential improvements. 
• Assist with technical and functional requirements gathering, documentation, and project management for new EDI implementations.
• Responsible for EDI Mapping, Transaction Validation, and testing.
...