• Health Care EDI Analyst

    Job Locations US-RI-Smithfield
    Req No.
    Operations Support
    Regular Full-Time
    IT/Software Development
  • Overview

    The Healthcare EDI Analyst is the primary point of contact for system interfaces between Neighborhood and our vendors.  The Healthcare EDI Analyst has primary responsibility to triage EDI/Interface issues and support operational needs.  The Healthcare EDI Analyst works directly with business units, our trading partners, and other areas of the Information Technology department.  The Healthcare EDI Analyst must be self-directed and solution oriented.  The Analyst will understand the operations and technology in use by the Business Area, ensure that all resources are being used effectively, and actively participate in identifying current problems and future needs of the department.  The Healthcare EDI Analyst will provide basic data analysis and IT analytical support to the aligned business areas. The Healthcare EDI Analyst works collaboratively with Information Services teams, and other Neighborhood departments to assist in the development of requirement documents, business cases and business plans.

    The Healthcare EDI Analyst is responsible for the management and maintenance of technology used to support EDI and custom interfaces for claims, member and financial information to and from Neighborhood’s trading partners and data to the State and CMS for Encounter reporting. The Healthcare EDI Analyst provides detailed knowledge, analysis and on-going support to the healthcare organization's electronic data interchange (EDI) programs, processes, systems and electronic information trading partners.


    • Responsible for performing data mapping using EDI software, supporting EDI software and the integration of EDI into application solutions, specification and design of logical business processes necessary to support standard based Healthcare transactions.
    • Develops technical specifications for EDI application interfaces and provides technical support and business analysis during and after implementation of healthcare EDI applications and updated transaction formats.
    • Responds to EDI inquiries and issues from internal organizations, trading partners, the state and CMS regarding healthcare transactions (enrollment, claims, encounter, status, payments) and clearinghouse activities.
    • Conducts various analyses of EDI transactions and formats and is responsible for format mappings, processing procedures and other EDI documentation as well as various EDI reporting.
    • Provides and communicates local expertise regarding standard concepts, practices and procedures of EDI formats (proprietary, NSF, ANSI, HIPAA).
    • Maintain knowledge EDI Industry standards, concepts, practices, and procedures
    • Maintain strong understanding and alignment with assigned Business Area: 
      • Strong understanding all technology in use by the Business Area
      • General understanding of other technologies in use at Neighborhood
      • Understanding of operational processes within the Business Area
      • Actively provide IS input to the operations and planning of the Business Area
    • Identifies and advocates for opportunities to bring additional IT value to the Business Area
    • Assist the EDI  Team Lead  in the development of business cases and/or business plans
    • Documents key work flows within the assigned Business Department
    • Creates end-user documentation on Neighborhood technology where necessary
    • Collaborates with the PMO on development of business cases and on project delivery
    • Provides department-facing business consulting support relative to Neighborhood’s healthcare payer system and other software applications.
    • Act as a liaison between department and technical groups, using his / her expertise in Neighborhood’s healthcare payer system and other software application expertise and superior communication skills to elicit, document, analyze and validate requirements
    • Apply industry-specific expertise to recommend and coordinate the development, enhancement, and maintenance of a department's business systems, processes, and products.
    • Combine industry expertise with a thorough understanding of information technology to develop innovative business solutions. Influence the strategic direction of the supported department(s).
    • Participate in analysis of large projects.
    • Participate in requirements management and change management processes.
    • Leverage industry knowledge and client relationships to assess the business implications of the application of technology to the current and future business environment and to identify new business opportunities.
    • Promote and direct process improvement activities and training of peers and department members
    • Provide time / resource estimates for assigned projects
    • Expected to develop innovative solutions to complex business and technology problems.
    • Other duties as assigned.
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.



    • Bachelor's degree in an Information Technology discipline, or sufficient years of experience and background equivalent to this degree
    • 3+ years of managed care/Healthcare experience required; Healthcare Issuer/payer environment preferred
    • At least 3 years of X12 EDI testing experience
    • Experience in X12 EDI Transactions (834 enrollment, 820 payments, 270/271 eligibility/response, 837I and 837P institutional and professional claims , 835 Healthcare Claim Payment Advice, 277CA Claim Acknowledgement, 999 transactions)
    • Experience with EDI HIPAA conversion
    • Deep knowledge of healthcare business processes and EDI infrastructures
    • Experience working with EDI standards (e.g., ASC X12, NSF, HL7).
    • Experience in supporting customers with a positive approach to solving problems and addressing business issues.
    • Demonstrates ambition and a willingness to develop knowledge and skills to perform as a consultant to customers to assist in EDI software installation and work with their business partners in implementing EDI and custom interfaces
    • Strong troubleshooting skills
    • Strong QA skills (Testing methodology, Test Case preparation, Test planning, Manual & Automated Testing)
    • Strong proficiency in communication with Business users, vendors, and technical staff is essential
    • Excellent SQL skills in writing queries
    • Excellent data analysis skills
    • Expert in the use of computer-based analysis tools, including Excel and Visio.
    • Must be a strategic thinker with strong analytical skills and the ability to perform and/or critique quantitative analyses, regulatory assessments, and operational plans
    • Ability to create both business requirements, technical requirements and end-user documentation
    • Ability  to work in a team environment and adjust to dynamic schedules and
    • Ability to work effectively and independently and has a strong work ethic
    • Strong organizational and prioritization skills   


    • Experienced in the use of HP Quality Center or similar tool
    • Experienced in the use of Cognos or similar tool
    • Experienced with HealthRules or similar rules-based claim processing system

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.


    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org


    Neighborhood is an EOE M/F/D/V and an E-Verify Employer


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