Edifecs Analyst

About Our Team

Our employees thrive in a culture that's fast-paced and ego-free, where innovation and collaboration are encouraged at every turn. We are an organization that provides federal agencies instant access to experienced and talented professionals who understand their unique challenges and know the most efficient ways to address them. We are continually investing in resources and talent, so we stay prepared with specialized teams in the place who are experts in creating tailored technologies. Our solutions empower Federal organizations to grow, modernize, and succeed in a rapidly evolving landscape.

We welcome diverse perspectives and seek individuals who are passionate about technology and creative problem-solving. If you enjoy learning, growing, and tackling real-world challenges, you will thrive here. Veterans and military spouses are strongly encouraged to apply and bring their unique experience to our team.

About the Role:

Our core values of People Matter, Integrity, and a Commitment to Excellence drive all that we do. By joining us, you will become a part of a fun and diverse team of talented and creative consultants who share the goal of using the latest technology to solve business challenges. We provide our clients with a dynamic mix of services and deliver focused solutions like no one else.

We are seeking talented and bright team players who are passionate about technology and want to work in a fast-paced, dynamic, and ego-free culture while applying a creative approach to problem-solving. Team members who like to grow their skill sets while solving challenging, real world business problems thrive.

We are seeking a skilled Edifecs Business Analyst/ X12 Subject Matter Expert (SME) to support the analysis, validation, and documentation of business requirements related to healthcare X12 transactions used by the Department of Veterans Affairs (VA). In this role, you will be responsible for ensuring that all business requirements accurately represent operational needs, based on a comprehensive understanding of the applicable X12 transaction sets.

This position offers high visibility and requires a confident EDI expert who can effectively engage with both business stakeholders and technical teams. Candidates should have a proven ability to analyze complex data sets, a thorough knowledge of healthcare EDI standards, and the confidence to act as a trusted advisor on EDI-related matters across the organization.

Key Responsibilities:

·      Review documentation such as EDI mappings, epics, and data flow diagrams to ensure accuracy, consistency, and completeness.

·      Identify gaps, ambiguities, or inconsistencies in business requirements; collaborate with stakeholders to refine and finalize requirements using in-depth knowledge of X12 standards, ensuring feasibility, alignment, and compliance with HIPAA and CAQH CORE operating rules.

·      Partner with technical teams to translate validated business requirements into detailed user stories and acceptance criteria.

·      Serve as the Subject Matter Expert (SME) on the X12 standard in development, providing guidance on transaction structures, including specific segments, loops, and data elements.

·      Ensure that the final implemented solutions accurately reflect EDI standards and business requirements within the system.

·      Support the development and validation of test plans, test cases, and test results to ensure alignment with user stories and defined acceptance criteria.

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Required Skills and Qualifications:

• In-depth understanding of HIPAA-compliant healthcare EDI transactions, including 837, 834, 835, 270/271, 276/277, and particularly deep understanding in X12 278 for prior authorization workflows.

• Strong expertise in X12 transaction structure, including loops, segments, and data elements; familiarity with X12 275 and X12 999 standards.

• Strong understanding of HIPAA-compliant EDI standards and implementation protocols, including CAQH CORE operating rules.

• Proven ability to validate EDI data against business requirements and technical specifications, including mapping of data between internal systems and X12 standards.

• Experience analyzing and documenting current-state business processes and translating them into optimized EDI workflows.

• Solid understanding of the end-to-end prior authorization process from a business and operational perspective.

• Strong analytical skills and proficiency in SQL for data validation, troubleshooting, and ad-hoc analysis.

• Experience working in Agile/Scrum environments, with the ability to contribute effectively to sprint planning and iterative delivery.

• Prior experience with government agencies and/or healthcare payers.

• Excellent written and verbal communication skills, with a strong attention to detail.

• Ability to anticipate, identify, and resolve complex problems independently and proactively.

• Proficient in creating clear, detailed, and comprehensive documentation, including:

o User stories and acceptance criteria in Jira

o Process flows and technical specifications.

• Strong collaboration skills with the ability to work across cross-functional teams.

• Confident in leading meetings, facilitating discussions, and driving alignment among stakeholders.

Preferred Qualifications:

• Basic understanding of Edifecs software and its role in EDI processing.

• Experience generating EDI test data for validation and testing purposes.

• Familiarity with creating and executing test cases using Postman for API testing.

• Prior experience working in a government or public sector environment.

• Proficiency with diagramming tools such as Microsoft Visio or Lucid chart for process and workflow visualization.