EDI Analyst

Immediate, Full-Time Employment opportunity for an EDI Analyst to join our client in the Glenn Burnie MD area! The selected candidate will support and enhance the quality of production operations through on-line maintenance of EDI and integrations to core claims systems, recommending and implementing improved methods/alternatives for operations.

- Analyze, Create, Maintain EDI transactions and inbound and outbound proprietary files.
- Assist in maintaining benefits, configuration and fee schedules in QNXT.
- Conduct testing of system changes. Actively participate in QNXT system upgrades
- Perform troubleshooting, create the root cause analysis, and propose solutions for issues found in:
1. Claims Payment
2. Claims accumulators
3. Benefit configuration
4. Provider
5. Contract configuration
6. Membership and Enrollment
7. Authorization
8. Medical Code Edits
9. Program set-up
- Coordinate with Applications Development Manager and Team Leads, in conjunction with the IT Project Manager, to ensure the priority of new work.
- Work with external vendors to escalate support issues to completion, scope business functional enhancement projects and validate recommended solutions to the organization.

Want to learn more about this opportunity! Then you should contact Elite Technical right away for consideration!

Required Skills

- B.S. degree in Public Health or Computer Science preferred, but direct experience may be substituted.
- Experience in working with HIPAA 5010 implementation guides and X12 ANSI EDI transactions. To include 837I, P, D; 834; 835; 278; 276 & 277; 270 & 271.
- A minimum of three to five years of QNXT or FACETS experience as an EDI Analyst, IT Analyst or Lead Test Analyst.
- Thorough understanding of all aspects of a claims processing system, including (but not limited to) EDI, claim adjudication, membership and enrollment, eligibility, configuration and benefits, authorizations and payment.
- Must have experience with benefit configuration setup and understand how to maintain the claims system codes (ICD10, CPT, HCPCS, CDT, fee schedules).
- Big Plus: Experience with code auditing tools such as iCES (from Optum) or ClaimsXten (from Lyric formerly ChangeHealth Care)
- Excellent technical and analytical skills.
- Good verbal and written communication skills. Ability to render and write business requirements such as technical documentation and business decision documentation.
- Proficiency in requirements gathering - effectively translating business needs as expressed by users into workable specs, estimating time\duration to complete and implement the solution.
- Microsoft SQL experience: Use/Write SQL queries to support technical design documents.
o Use/ Write SQL to support troubleshooting activities.
o Use/Write SQL queries to support testing / validation activities.

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Glen Burnie, MD



Anticipated Start Date

Monday, July 31, 2023

Job Type

Direct Hire

Anticipated Duration

Direct Placement

Date Posted

Monday, July 10, 2023

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Elite Technical Services, Inc. participates in the E-Verify program to confirm the employment eligibility of all persons hired. This means that we will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization. Elite Technical Services, Inc. will not use E-Verify to pre-screen job applicants.

Elite Technical Services, Inc. is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.