EDI Analyst
Zelis is pursuing an aggressive organic and non-organic growth strategy focused on providing superior healthcare claim lifecycle solutions to payors, providers and individuals from pre-payment through payment. As the company executes its growth strategy, Zelis is currently hiring an EDI Analyst. The position will report to an EDI Manager and will work closely with managers and various team members.
Use advanced test editors and other technology tools to review X12 835 files for issues, to include but not limited to the following:
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Balance, structure, syntactical, data type and content errors; to develop and execute strategies to solve them.
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Troubleshoot by querying the database using SQL Management Studio to review stored values and/or using a text editor to manually review data files sent to Zelis by our Payer clients.
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Support Payer and Provider client implementation activities by generating 835 files, reviewing content and then presenting findings to Zelis clients.
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Respond to inquiries regarding 835 issues, claims, payments, and/or clearinghouse activities.
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Interacting with other departments on communication issues related to customer and third-party vendor connectivity.
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User acceptance testing to approve items for release.
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Communicate with vendor contacts to identify file issues and disseminate the resolution to the provider or payer to maintain compliance with all HIPAA and Zelis data security standards.
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Support multiple client projects simultaneously.
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Ensure proper follow up and completion of projects.
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Work under pressure with multiple deadlines.
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Work on assignments that are complex in nature in which judgment, critical thinking and initiative are required to accomplish the objectives of the assignment.
REQUIRED EXPERIENCE:
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3+ years EDI experience to include 1 year of healthcare
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Technical solution guidance & design – user acceptance testing
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Create, lead and facilitate presentations to Operations team, and internal & external stakeholders & clients
PREFERRED EXPERIENCE:
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Bachelor’s degree
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EDI files (fixed length, delimited, X12 and/or EDI 835) and adjudication systems
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SQL knowledge
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Advanced test editors or other technology tools
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Provider billing and/or claims payment experience helpful
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Excellent communication skills
Location and Workplace Flexibility:
We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.
Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.
Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email [email protected].
SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.
Top Skills
What We Do
As a leading healthcare payments company, we price, explain and pay for care on behalf of payers, providers, and healthcare consumers. Zelis was founded on a belief there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment because more affordable and transparent care is good for all of us. We partner with over 700 payers, 1.5 million providers, and millions of members -- enabling the healthcare industry to pay for care, with care.
Zelis brings adaptive technology, a deeply ingrained service culture, and an integrated pre-payment through payments platform to manage the complete payment process.
