Job Title: EDI Analyst – Healthcare Insurance Eligibility Data Specialist
Job Summary:
We are looking for a highly skilled EDI Analyst with deep expertise in healthcare eligibility and benefits data and X12 270/271 transactions to join our growing technology team.
This is not a typical EDI role — in addition to managing eligibility transactions, you will work side-by-side with software engineers and data architects to build a modernized, scalable eligibility data normalization engine. Your knowledge of real-world payer data formats and transaction nuances will be key to shaping how eligibility data is standardized and served across our platforms.
If you are passionate about healthcare data, love solving complex data mapping challenges, and want to collaborate directly with developers to build the next generation of eligibility systems, we’d love to hear from you.
Essential Functions:
- Serve as the subject matter expert for HIPAA X12 270/271 healthcare eligibility transactions.
- Collaborate with software engineers to design, test, and deploy a robust eligibility response normalization framework.
- Translate messy, payer-specific 271 responses into clean, consistent internal data models.
- Develop business rules, mapping logic, and validation checks to power automated eligibility workflows.
- Analyze and troubleshoot EDI data issues across payer, clearinghouse, and internal systems.
- Build payer profiles documenting eligibility and benefit response patterns and anomalies.
- Work with product and engineering teams to define and refine eligibility service APIs.
- Support new payer integrations and optimize existing eligibility connectivity.
- Ensure all processes align with HIPAA regulations, industry standards, and security best practices.
- Create detailed documentation including data flow diagrams, normalization specs, and payer-specific business logic.
- Conduct audits and reconciliation of eligibility data to ensure completeness, accuracy, and system integrity.
Minimum Requirements:
Specific Job Skills:
- 3+ years of professional experience working with X12 270/271 transactions and healthcare eligibility data.
- Strong working knowledge of healthcare payer/provider EDI systems and HIPAA transaction standards.
- Experience partnering closely with software development teams on data transformation or integration projects.
- Ability to read and analyze raw EDI files at the loop/segment/element level.
- Hands-on experience in SQL for querying, validating, and troubleshooting eligibility and benefits data.
- Strong analytical mindset with an eye for patterns, inconsistencies, and data quality improvements.
- Excellent communication skills, with the ability to bridge business needs and technical execution.
- Comfortable working in an agile, fast-paced, collaborative environment.
Preferred Qualifications:
- Experience with healthcare APIs (e.g., X12 transaction sets, HL7, FHIR).
- Familiarity with other revenue cycle healthcare EDI transaction sets such as 834, 837, and 835.
- Experience supporting eligibility transactions across multiple payer types (commercial, Medicaid, Medicare).
- Background working with ETL pipelines, MFTs, and/or cloud data platforms (e.g., AWS, Azure).
Supervision: N/A
Certifications: N/A
Language Skills:
Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or governmental regulations. Ability to write reports, business correspondence and procedure manuals. Ability to effectively present information and respond to questions from a variety of both internal and external sources.
Physical Capabilities: Standard categories
The physical capabilities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
RevSpring is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
Note: This Job Description may not describe all of the job responsibilities and standards assigned to this position. The duties may change from time to time. RevSpring does not discriminate against any group in hiring or employment practices. Nothing in this job description constitutes a contract for employment.
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