Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or related field; equivalent experience accepted
2+ years of experience in data analysis, integration, or EDI within healthcare
Strong understanding of healthcare claim adjudication processes
Knowledge of EDI SNIP validations and familiarity with tools like EDIFECS
Proficiency in SQL, Excel, and JSON preferred
Strong attention to detail and commitment to data accuracy
Understanding of HIPAA compliance and healthcare regulations
Responsibilities
Design and maintain data mappings and transformations for healthcare data files
Collaborate to define data requirements and specifications with internal and external teams
Onboard, test, and certify new connections and transaction sets
Develop data validation rules to ensure accuracy and consistency of exchanged data
Proactively resolve data discrepancies and perform root cause analysis
Monitor system status and identify potential data quality issues
Analyze data trends to identify areas for improvement
Benefits
Flexible work responsibilities allowing for reassignment as needed
Commitment to data integrity and compliance
Opportunities for growth in a dynamic environment
Ability to collaborate with diverse teams
Access to industry best practices and training opportunities
Full Job Description
Position Summary:
The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between Capital Rx - JUDI Health and its various partners, including employers, providers, and other TPAs. This role focuses on the technical aspects of data integration, file transformation, error resolution, and ongoing monitoring of data feeds for medical, dental, and vision claims. The ideal candidate will possess a strong understanding of healthcare data formats, excellent analytical skills, and a commitment to data integrity and compliance.
Position Responsibilities:
Data Integration & Mapping:
Design, develop, and maintain data mappings and transformations for incoming and outgoing healthcare data files: 837/835 - claims & remittance, 270/271 - eligibility and responses, 278 - Prior Auth, 276/277 - claim status, 999/TA1 - file level acknowledgement as well as proprietary formats
Collaborate with internal teams (e.g., Client Services, Claims, IT Development) and external partners (e.g., clearing houses or third-party administrators) to define data requirements and specifications
Work with business teams and trading partners to onboard, test and certify new connections and transaction sets
Data Quality & Validation:
Develop and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged data
Proactively identify and resolve data discrepancies, errors, and rejections in a timely manner
Perform root cause analysis for data issues and implement preventative measures
Monitoring & Support:
Proactively monitoring system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy
Provide technical support and troubleshooting for data exchange issues, working with internal and external stakeholders to resolve problems
Document data exchange processes, configurations, and troubleshooting steps
Process Improvement & Automation:
Identify opportunities to optimize and automate data exchange processes, improving efficiency and reducing manual effort
Stay current with industry best practices, new technologies, and regulatory requirements related to healthcare data exchange
Reporting & Analysis:
Generate reports on data exchange performance, error rates, and key metrics
Analyze data trends to identify potential issues or areas for improvement
Analyze data trends to identify potential issues or areas for improvement
Participate in projects with Data Exchange impacts including vendor changes, client migrations, and client add-on requests
Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.
Required Qualifications:
Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or a related field. Equivalent work experience may be considered
Knowledge of healthcare claim adjudication processes for medical, dental, and vision
Strong knowledge and familiarity with EDI SNIP validations and one of the most widely used tools in the healthcare industry (e.g., EDIFECS)
2+ years of experience in data analysis, data integration, or EDI (Electronic Data Interchange) specifically within the healthcare industry
Strong understanding of healthcare EDI transactions (e.g., 834 Enrollment, 837 Professional/Institutional/Dental Claims, 835 Remittance Advice)
Excellent analytical, problem-solving, and critical thinking skills
Familiarity with various file transfer protocols (FTP, SFTP, FTPS)
Understanding of HIPAA compliance and other relevant healthcare regulations
Strong attention to detail and a commitment to data accuracy
Ability to analyze complex business problems to discover and resolve root causes
Proficiency in SQL, Excel, JSON and other technical data skills preferred
Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders
Self-motivated and detail-oriented problem solver
Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team
This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
New York, NY Salary Range
$96,800-$121,000 USD
Denver, CO Salary Range
$88,800-$111,000 USD
Charlotte, NC Salary Range
$80,800-$101,000 USD
All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
