Overview TISTA Science and Technology is seeking a Senior Healthcare HIPAA EDI Data Analyst who will work as a subject matter expert working with EDI data and business processes. TISTA associates enjoy above Industry Healthcare Benefits, Remote Working Options, Paid Time Off, Training/Certification opportunities, Healthcare Savings Account & Flexible Savings Account, Paid Life Insurance, Short-term & Long-term Disability, 401K Match, Tuition Reimbursement, Employee Assistance Program, Paid Holidays, Military Leave, and much more! Stay Connected: Follow us onLinkedInfor updates on this job and other exciting opportunities. Responsibilities + Provides subject-matter expertise on available data and quantitative solutions + Identifies the best combination of available data, analytical methods, and presentation for analytic solutions + Analyzes business data for actionable intelligence + Evaluates data-centric tasks to determine the appropriate analytic approaches + Coordinates work of data analysts, providing subject-matter expertise and guidance + Performs data-mining, modeling and develop customized algorithms to solve analytical problems with incomplete data sets + Develops proper algorithms in order to establish the desired linkage between the existing data in the warehouse and the new data set + Tracks data lineage of benefits to cost, eligibility and enrollment data, provider to beneficiary, and program to utilization + Collaborates with product management and engineering team to understand needs and devise possible solutions + Keeps up-to-date with latest technology trends + Oversee Comprehensive EDI Transactions: Manage and ensure the smooth execution of all HIPAA-compliant EDI transactions, including: + 837:Claims (Institutional, Professional, Dental) + 835:Payment and Remittance Advice + 270/271:Eligibility and Benefits Inquiry/Response + 276/277:Claim Status Inquiry/Response + 278:Referrals and Authorizations + 834:Benefit Enrollment + 820:Premium Payments + Optimize Transaction Lifecycles: Analyze the entire EDI transaction lifecycle to identify bottlenecks, errors, and inefficiencies, implementing data-driven solutions to streamline processes and improve performance. + Error Resolution and Collaboration: Lead initiatives to address and resolve claim rejections, eligibility errors, and payment discrepancies. Collaborate with providers, payers, and clearinghouses to maintain seamless data exchange and compliance. + Technical Expertise: + Possess extensive experience with HIPAA-compliant EDI transactions and ASC X12 standards. + Leverage proficiency in EDI tools, mapping technologies, and data transformation platforms. + Demonstrate strong knowledge of healthcare coding standards, including ICD-10, CPT, HCPCS, and NDC. + Advanced Data Analysis: + Troubleshoot complex EDI issues using tools such as SQL, mapping software, and integration platforms. + Optimize database queries and develop detailed reports to provide actionable insights on EDI data trends and system performance. + Leadership and Process Improvement: Act as the primary point of contact for all EDI-related issues, ensuring timely resolution and fostering continuous process enhancements to improve efficiency and compliance. + Cross-Functional Collaboration: Partner with IT, compliance, operations, and other stakeholders to design, implement, and refine EDI solutions aligned with organizational objectives. + Mentorship and Team Development: Provide mentorship to junior analysts, sharing knowledge and expertise to foster team development and ensure consistency in EDI operations. Qualifications + 5 yrs relevant experience in data-mining, modeling and EDI based transactions + Experience mapping and supporting EDI based transactions i.e., 837, 835, 270/271, 276/277, 278, 834, and 820 + Knowledge of EDI, X12/EDIFACT standards and practices, and EDI translators + EDI experience (setup, mapping, testing, processing, troubleshooting) + Proficient in EDI layouts (loops, segments, data elements) + Perform EDI onboarding and testing with applicable third-party providers + Create workflows, process flows, and Manage EDI Maps and Connections + Create project plans, test plans, conduct end to end testing + Translator tool knowledge and experience + Working with SQL Server databases + Experience in ETL/Data Warehousing skills + Experience in SAFe Agile team environment driving stand up, backlog grooming, and iteration planning Experience in a customer–facing role, including comprehending business needs, solving complex problems, and capturing business requirements to convert them into technical requirements + Experience working on Federal programs that are of high priority, visibility, and public-facing + Experience with Agile delivery programs + Must be able to work quickly with a high degree of accuracy with cross-functional teams + Able to work under minimal supervision, act independently and exercise an expert level of decision-making capability + Demonstrated ability and experience using Microsoft Office Suite including Word, PowerPoint, Excel, Visio, and Access Education + Bachelor of Science degree Clearance: + The ability to pass a Moderate Background Investigation (MBI) Location: + Remote, USA Pay Range: The pay for this position ranges from $79,240 to $92,500 The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and location. Also, certain positions are eligible for additional forms of compensation, such as bonuses. TISTA associates are eligible to participate in our comprehensive benefits plan! More information can be found here: https://tistatech.com/working-at-tista/ TISTA Science and Technology Corporation,a CMMI Maturity Level 3 company, focuses on delivering information technology and professional services to Federal and State agencies. TISTA is recognized in 2019 by Inc. 5000 as one of the fastest-growing private companies in the US. TISTA is also a recipient of 2019 Top Veteran-Owned Companies by the Washington Business Journal. TISTA also received a 2018 Moxie Award in the GovCon category. Here at TISTA Science and Technology, we value Veterans and encourage all to apply! #thinktista #tistacares #tistavaluesvets Employment Transparency: TISTA is an Equal Opportunity/Affirmative Action Employer and embraces diversity in our employee population. It is the policy of TISTA to provide equal opportunity to all qualified applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or genetic information. TISTA will refrain from discharging, or otherwise discriminating against, employees or applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees or applicants. The EEO is the Law poster is available here, and the poster supplement is availablehere. (https://www.eeoc.gov/employers/upload/poster\_screen\_reader\_optimized.pdf) The Pay Transparency Policy is availablehere. (https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp\_%20English\_formattedESQA508c.pdf) Tista is committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation due to a disability for any part of the employment process, please send an e-mail torecruiting@tistatech.comor call (301) 968-3420 and let us know the nature of your request and your contact information. TISTA is a federal contractor and is subject to the federal contractor COVID requirements under the new FAR/DFARS clauses and must comply with the incorporated Guidance. If the candidate is hired to perform work on or in connection with one of TISTA’s federal contracts, TISTA is contractually obligated to ask the candidate to verify and show proof of vaccination status and the candidate will be required to comply with mask and social distancing requirements imposed by the FAR/DFARS as well as any additional requirements imposed by TISTA’s customers for any required onsite work. Job ID2025-5534 Job LocationsUS-Remote-United States