About the Role
The EDI Business Implementation Analyst is responsible for leading eBusiness implementations and coordination of activities across multiple functional areas.
Essential Functions:
-Coordinate and support the implementation of new Medicaid, Commercial and Marketplace lines of business by ensuring claims intake requirements are clearly defined and met
-Manage setup, testing and validation of EDI Transactions (837,999 ,277CA, 278, 270/271, 276/277, etc.) to ensure compliance with HIPAA and payer specific requirements
-Oversee workflows and systems for intake, imaging and data capture of paper claims ensuring timely and accurate conversion to electronic format
-Partner with IT, Provider Services, Configuration, Claims Operations and eBusiness Leadership to ensure smooth integration and readiness for go-live activities.
-Develop and document business requirements for claims intake and processing, ensuring alignment with regulatory and operational standards
-Design and execute test plans for claims intake systems and processes, including EDI and paper claims to ensure accurate data transmission and adjudication
-Identify, analyze and resolve issues related to claims intake and data discrepancies during implementation and ongoing operations
-Ensure all claims intake process comply with CMS, state Medicaid and other regulatory requirements specific to each line of business
-Track key performance indicators related to claims intake timeliness, accuracy and rejection rates. Provider actionable insights to stakeholders
-Develop training materials and process documentation to support internal staff and stakeholders understanding new business specific rules
Requirements
-Bachelor’s degree or equivalent years of relevant work experience is required
-Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
-3-5 years of SQL experience required including the ability to write and execute complex queries
Competencies, Knowledge and Skills:
-Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.)
-Advanced knowledge of ANSI X12 guidelines includes syntax, editing requirements and best practicesÂ
-Advanced computer skills in Microsoft Word, Excel, Outlook & Visio
-Demonstrated exceptional communication (verbal and written) and high level of professionalism
-Data analysis and trending skills to include query writing Knowledge of Claims IT processes and systemsÂ
-Working knowledge of managed care and health claims processingÂ
-Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
-Demonstrates excellent analysis, collaboration skills, facilitation and presentation skills
-Strong interpersonal, leadership and relationship building skills
-Effective decision making and problem-solving skills
-Ability to work independently and within a team environment
-Time management skills; capable of multi-tasking and prioritizing work
-Attention to detail
-Critical thinking and listening skills
-Facets knowledge preferred
-Knowledge of Agile framework preferred
Edifecs Transaction Management knowledge required
About the Company
RepuCare, a certified Woman Owned Business (WBE), is a leader in providing innovative workforce solutions. We have partnered with a large managed care provider seeking an EDI Business Implementation Analyst to support a temporary contract through Jan of 2026.