[Hiring] EDI Healthcare Analyst @Xlysi

Role Description

We are looking for experienced EDI Healthcare Analysts with strong expertise in encounter data processing, EDI submission, reconciliation testing, and member enrollment workflows for a healthcare payer.

Qualifications

• Experience in encounter data processing, EDI submission, and reconciliation testing for a healthcare payer.
• Facets — REQUIRED: claims module familiarity (encounters are derived from Facets claims data); Facets-to-encounter data validation.
• X12 EDI knowledge: 837P, 837I, 837D (Professional, Institutional, Dental) — transaction structure, loops, segments.
• 277CA (Claim Acknowledgement) and 999/TA1 validation.
• Encounter submission & acceptance rules — Medicaid, Medicare Advantage, TRICARE, Marketplace.
• Experience with Edifecs or equivalent EDI validation tooling.
• SQL for encounter data validation (claim header, detail, member eligibility cross-checks).
• TOSCA or Robot Framework test automation.
• Healthcare payer domain knowledge including CMS encounter submission rules and state-specific companion guides.
• Facets — REQUIRED: membership/enrollment module testing, subscriber/member configuration, and 834-to-Facets data flow validation.
• X12 EDI: 834 (Benefit Enrollment & Maintenance) — full transaction expertise.
• Experience with member add/change/term, dependent handling, dual-enrollment scenarios.
• Knowledge of retroactive adjustments and deeming logic (Medicaid/MMP/Dual).
• 820 (Premium Payment) validation linkage.
• Member eligibility cross-validation (270/271 correlation).
• Enrollment reconciliation: source system vs. downstream (enrollment DB ↔ claims ↔ eligibility).
• SQL for member-level data comparisons (effective dates, plan codes, LOB flags).
• Experience with TOSCA or similar automation tools.
• LOB knowledge: Medicaid, Medicare Advantage, Duals/MMP, TRICARE, Marketplace.

Requirements

• Remote (US Only)
• W2 Employment Type
• Rate: $40/hr (No Benefits)

Benefits

• No Benefits

Company Description

HR: Xlysi LLC, Expert Portal Solutions

Address: 251 Milwaukee Ave, Buffalo Grove, IL 60089

Web: http://www.xlysi.com

E-mail: [email protected]

Our training portal registration: Training Portal