Lead Electronic Data Interchange (EDI) Analyst

Description

We are seeking a highly skilled and motivated Lead EDI Analyst to join our EDI Business Operations team. This role is responsible for managing, processing, and optimizing Electronic Data Interchange (EDI) workflows that support payer-side healthcare transactions. Key responsibilities include oversight of transactions such as Eligibility Benefit Inquiry/Response (270/271), Claim Status Request/Response (276/277), Claims Acknowledgement (277CA), Authorization Request/Response (278), Claims (837I/837P/837D), Electronic Remittance Advice (835), and Implementation Acknowledgement (999), spanning multiple lines of business.

The Lead EDI Analyst drives key initiatives to enhance claims processing, eligibility verification, and payment accuracy, while ensuring full compliance with HIPAA regulations and industry standards. This role is central to optimizing healthcare data exchange and supporting operational excellence across the organization.

We're looking for a detail-oriented, analytical professional who thrives in a collaborative environment and is passionate about continuous improvement and innovation. The ideal candidate will lead efforts to deliver scalable, efficient EDI solutions that strengthen our internal systems and external partner communications.

As a member of our EDI team, the Lead Analyst will contribute to maintaining the integrity and efficiency of our operations. We value teamwork, proactive problem-solving, and empowering our employees to lead with purpose and impact.

Responsibilities include, but are not limited to:

• Proactively monitor and analyze production EDI activity to ensure data quality, accuracy, and compliance with mapping specifications, regulatory requirements, industry standards, performance benchmarks, and internal policies.
• Continuously monitor system health throughout the day to support real-time EDI transactions and minimize disruptions
• Work closely with internal stakeholders to support accurate and timely EDI file processing
• Engage in cross-functional collaboration with internal business and IT teams, along with external partners and vendors, to resolve issues and guarantee smooth EDI operations
• Coordinate with Trading Partners, Account Teams, Providers, and Claims Teams to identify, troubleshoot, and resolve EDI-related issues efficiently
• Lead EDI initiatives, including new implementations and system upgrades, ensuring timely execution and alignment with business goals
• Facilitate stakeholder engagement throughout the project lifecycle, maintaining clear communication, accountability, and collaboration across internal teams and external partners
• Define and document business requirements and mapping specifications for electronic data exchange, ensuring seamless integration between client and internal systems
• Participate in requirement review sessions with stakeholders, subject matter experts, and trading partners to validate business needs
• Maintain clear documentation and workflows for EDI changes and mapping updates using Microsoft Word, Excel, PowerPoint, and Visio
• Collaborate with the Testing Team to design and execute comprehensive test plans and scenarios for defect resolutions, system enhancements, and project initiatives
• Support end-to-end testing and validate results through detailed review and approval
• Coordinate testing activities with external vendors to ensure alignment, quality, and timely execution of deliverables
• Provide support for production checkout and monitor post-implementation defect tracking to ensure stability and performance
• Identify and recommend process improvements to enhance operational efficiency and testing effectiveness
• Perform additional responsibilities and tasks assigned to support team and organizational goals

Qualifications

• Bachelor's degree from an accredited institution preferred or equivalent work experience
• 7+ years of experience in EDI transaction processing, preferably in a healthcare, managed care or insurance environment
• Strong knowledge of HIPAA EDI standards (especially 270/271, 276/277, 277CA, 278, 837, 835, 999/TA1)
• Experience with EDI tools, translators, and transaction monitoring systems
• Excellent analytical, problem-solving, and communication skills
• Demonstrated ability in planning, organizing, and executing tasks effectively
• Ability to manage multiple priorities in a fast-paced environment
• Strong working knowledge of Microsoft Office suite, including:
  • Excel: proficient in creating formulas, using VLOOKUPs, building pivot tables, and performing data analysis
  • Word, PowerPoint, and Visio: skilled in developing documentation, creating presentations, and mapping business processes

Additional Preferred Experience:

• Working knowledge of SQL to support defect analysis and resolution
• Knowledge of BCBSA Blue Exchange transaction processing

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.