JOB DESCRIPTION :

We are seeking a detail-oriented and experienced System Analyst 2 to join our team. The ideal candidate will be responsible for testing, validating, and ensuring the accuracy of EDI transactions related to healthcare claims. This role involves working closely with developers, business analysts, and EDI teams to ensure that claims data meets internal standards and regulatory compliance (HIPAA, CMS, etc.).

PREFERRED QUALIFICATIONS:

• Bachelor’s degree in Information Systems, Computer Science, Healthcare Administration, or related field.
• 3+ years of QA experience in healthcare EDI testing, particularly with claims.
• Strong understanding of X12 EDI formats (837, 835, 999, etc.).
• Experience working with EDI tools such as Edifecs or similar.
• Proficient in SQL for data analysis and validation.
• Familiarity with healthcare billing processes, coding standards (ICD-10, CPT, HCPCS), and payer systems.
• Excellent documentation and communication skills.

PREFERRED SKILLS:

• Experience with Medicaid/Medicare claims processing.
• Familiarity with Agile/Scrum methodologies.
• Exposure to API testing using tools like Postman or SOAP UI.
• Knowledge of claims adjudication systems (e.g., Facets, Healthrules).

QUALIFICATIONS

• EDUCATION - Bachelor’s or 4 years of work experience above the minimum qualification
• EXPERIENCE - 4 Years of Experience
• Hybrid expectation- on-site as needed

• Analyze, test, and validate healthcare EDI transactions, including:
• 837 (Claims)
• 835 (Remittance Advice)
• 999 (Acknowledgements)
• 277CA (Claims Acknowledgment)
• Review and validate EDI mapping, transformation logic, and integration points.
• Design and execute test plans, test cases, and test scripts for EDI-related applications and workflows.
• Perform system, regression, integration, and user acceptance testing (UAT).
• Collaborate with developers and analysts to identify, log, and resolve defects using tools like JIRA or HP ALM.
• Conduct root cause analysis for EDI errors and provide resolution recommendations.
• Ensure compliance with HIPAA, payer guidelines, and internal business rules.
• Create detailed documentation, QA reports, and audit logs.
• Participate in release management and deployment testing processes.