Note: The job is a remote job and is open to candidates in USA. Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. They are seeking an experienced EDI Analyst II to support and optimize healthcare EDI integrations, focusing on ANSI X12 5010 835 transactions while collaborating with cross-functional teams to ensure data accuracy and compliance.
Responsibilities
- Analyze and troubleshoot complex ANSI X12 5010 835 (ERA) transactions, identifying processing, formatting, balancing, and compliance issues
- Perform root cause analysis, resolve EDI processing issues, and implement preventive solutions
- Design and maintain EDI integration workflows, data mappings, technical documentation, and testing plans
- Interpret payer and provider specifications to ensure compliance with HIPAA, ANSI X12, and trading partner requirements
- Generate, validate, and review EDI files, communicating findings and recommendations to internal teams and clients
- Serve as the technical point of contact for escalated 835 remittance, provider payment, and clearinghouse issues
- Partner with internal teams, clients, vendors, and trading partners to resolve integration, connectivity, and workflow challenges
- Leverage AI-enabled tools and automation to improve data quality, validation, reconciliation, and operational efficiency
- Manage multiple priorities, document best practices, ensure HIPAA compliance, and identify process improvement opportunities
- Mentor junior analysts and stay current with healthcare EDI standards, integration technologies, and AI advancements
Skills
- Bachelor's degree in Information Systems, Healthcare Administration, Computer Science, or a related field, or equivalent experience
- 5–7+ years of healthcare EDI experience, including 3–5+ years supporting HIPAA ANSI X12 835 transactions
- Strong understanding of the healthcare claims lifecycle, payment processing, provider payment posting, and reconciliation
- Experience with EDI validation tools (Edifecs, Crystal Validation), ANSI X12 standards, data mapping, and healthcare integration processes
- Advanced SQL and data analysis skills
- Proficiency with Microsoft Teams, Word, Excel, Notepad++, and AI tools such as ChatGPT
- Excellent analytical, communication, troubleshooting, and problem-solving skills
- Experience with 837, 834, and 270/271 is a plus
- Microsoft SQL Server experience preferred
- Jira, C#, or API experience is a plus
Benefits
- 401k plan with employer match
- Flexible paid time off
- Holidays
- Parental leaves
- Life and disability insurance
- Health benefits including medical, dental, vision, and prescription drug coverage
Company Overview