Job Hybrid Onsite - EDI Systems Analyst is shared with you

[Sheldon Fernandez]

Hope you are doing well. We have an open position for a Senior Systems Analyst at Baltimore, Maryland (Hybrid Onsite). Please review the description below and let me know your interest. If you are interested, please share your resume, rate/salary expectations, and the best time to reach you.

Client: The Maryland Health Benefit Exchange (MHBE)
Location: Baltimore, Maryland (Hybrid Onsite)
Job ID: 150
 
MHBE / Project Background:
The Maryland Health Benefit Exchange (MHBE), an independent unit of state government, provides accessible, affordable health coverage to Marylanders.  MHBE administers Maryland Health Connection (MHC), the state’s health insurance marketplace. Through MHC, Maryland residents explore health insurance plans, compare rates, and determine their eligibility for advanced premium tax credits (APTC), cost-sharing reductions (CSR), and public assistance programs such as Medicaid and the Maryland Children’s Health Insurance Program (MCHP).    
MHBE seeks Senior Systems Analysts to provide Electronic Data Interchange (EDI) data analysis, transaction and support services, and other related services.
 
Duties / Responsibilities:

• Provide data analysis, transactional support, error detection, resolution, and all related services for the successful Electronic Data Interchange (EDI) Operations of the Exchange.
• Perform 8001 Medicaid transaction file analysis and validations.
• Review and resolve all data issues, including but not limited to Master Data Management (MDM), Master Person Identifier (MPI), and other data issues.
• Perform HBX System Error analysis.
• Validate 1095-A and 1095-B files, and reconcile 8001 transactions.
• Analyze EDI files sent to and received from Carriers, Managed Care Organizations (MCO), and other entities, and identify errors and root causes for EDI file rejections.
• Coordinate with the development team, business team, and testing team to analyze, fix, test, and transmit EDI files daily and as required.
• Analyze the EDI 999 files from the Carriers and MCOs and perform root cause analysis for exceptions, and assist with resolving any data issues.
• Perform data changes to fix consumer or system-reported errors, coordinate with technical and business teams to analyze error reports, access the HBX databases and applications to perform root cause analysis for transaction rejections, and provide data fixes and technical solutions.
• Communicate with the IT team, business team, vendor teams, and other stakeholders to translate business needs into EDI data fixes and solutions.
• Note: The consultant must have the flexibility to work overtime, as needed, including weekends, holidays, and off-hours.

 
Minimum Qualifications:

• A minimum of four (4) years of experience with the Health Exchange marketplace EDI solutions.
• A minimum of four (4) years of experience creating EDI X12 files for transaction sets such as 834, 999, and TA1.
• A minimum of four (4) years of experience in reviewing and understanding technical documents such as companion and implementation guides for Healthcare EDI formats 834 and 999.
• A minimum of four (4) years of experience in analyzing, testing, and providing data solutions for healthcare marketplaces.
• A minimum of two (2) years of experience working with SQL databases/queries.
• Strong analytical and problem-solving skills.
• Excellent communication skills, including the ability to understand and communicate technical information to business users and gather business requirements that can be translated into technical requirements.
• Ability to manage multiple critical priorities and tight deadlines.

 
Preferred Qualifications:

• A minimum of six (6) years of experience with EDI validation tools such as Edifecs, WTX, EDI X12 files, or equivalent.
• A minimum of six (6) years of experience with EDI transaction sets such as 834, 820, 999, and TA1, SOA, EDI, or EAI applications.
• A minimum of two (2) years of hands-on experience writing complex SQL scripts.
• Knowledge of the Affordable Care Act (ACA) eligibility rules for Medicaid and Qualified Health Plans.
• Experience with or knowledge of Medicaid 8001 file processing or any other inter-agency transactional file processing.
• In-depth understanding of EDI 834 enrollment transactions, including Adds, Changes, Terminations, Cancellations, and error processing.

Thanks,
Sheldon Fernandez
she...@elegantsolutions.us      

Elegant Enterprise-Wide Solutions, Inc

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