EDI Business Implementation Analyst

Company: ALTA IT Services
Location: Dayton
Posted on: May 22, 2025

Job Description:

Title: EDI Business Implementation Analyst

The information below covers the role requirements, expected candidate experience, and accompanying qualifications.
ALTA is supporting an 8-month contract opportunity working 100% remote.

ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.

The EDI Business Implementation Analyst is responsible for leading eBusiness implementations and coordination of activities across multiple functional areas. Edifecs Transaction Management knowledge required.

Essential Functions:

Coordinate and support the implementation of new Medicaid, Commercial and Marketplace lines of business by ensuring claims intake requirements are clearly defined and met
Manage setup, testing and validation of EDI Transactions (837,999 ,277CA, 278, 270/271, 276/277, etc.) to ensure compliance with HIPAA and payer specific requirements
Oversee workflows and systems for intake, imaging and data capture of paper claims ensuring timely and accurate conversion to electronic format
Partner with IT, Provider Services, Configuration, Claims Operations and eBusiness Leadership to ensure smooth integration and readiness for go-live activities.
Develop and document business requirements for claims intake and processing, ensuring alignment with regulatory and operational standards
Design and execute test plans for claims intake systems and processes, including EDI and paper claims to ensure accurate data transmission and adjudication
Identify, analyst and resolve issues related to claims intake and data discrepancies during implementation and ongoing operations
Ensure all claims intake process comply with CMS, state Medicaid and other regulatory requirements specific to each line of business
Track key performance indicators related to claims intake timeliness, accuracy and rejection rates. Provider actionable insights to stakeholders
Develop training materials and process documentation to support internal staff and stakeholders understanding new business specific rules


Education and Experience: Bachelor's degree or equivalent years of relevant work experience is required
Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
3-5 years of SQL experience required including the ability to write and execute complex queries


Competencies, Knowledge and Skills: Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.)
Advanced knowledge of ANSI X12 guidelines includes syntax, editing requirements and best practices
Advanced computer skills in Microsoft Word, Excel, Outlook & Visio
Demonstrated exceptional communication (verbal and written) and high level of professionalism
Data analysis and trending skills to include query writing Knowledge of Claims IT processes and systems
Working knowledge of managed care and health claims processing
Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
Demonstrates excellent analysis, collaboration skills, facilitation and presentation skills
Strong interpersonal, leadership and relationship building skills
Effective decision making and problem-solving skills
Ability to work independently and within a team environment
Time management skills; capable of multi-tasking and prioritizing work
Attention to detail
Critical thinking and listening skills
Facets knowledge preferred
Knowledge of Agile framework preferred


Licensure and Certification: None



Ref: #860-IT Cincinnati

Keywords: ALTA IT Services, Middletown , EDI Business Implementation Analyst, Professions , Dayton, Ohio