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Title: Senior Healthcare EDI Integration Analyst
Company: Confidential Healthcare Organization
Industry: Healthcare
Location: Remote
Employment Type: Contract
Overview
We are seeking a Senior Healthcare EDI Integration Analyst to serve as the primary technical resource supporting a rapidly growing Medicare and Medicaid EDI environment with significant planned workload through 2027. This is a hands-on production support role requiring an experienced professional who can independently maintain mission-critical EDI operations while ensuring uninterrupted claims processing and trading partner communications.
The successful candidate will take ownership of the organization's Healthcare EDI platform built on the latest versions of TIBCO BusinessConnect (BC), TIBCO BusinessWorks (BW), and TIBCO Foresight. This individual will monitor production processing, resolve transaction failures, investigate rejected files, support claims reconciliation, coordinate testing, and work directly with internal business teams and external trading partners to ensure timely and accurate healthcare data exchange.
This role requires someone who thrives in a high-volume production environment, works independently with minimal supervision, and can quickly diagnose and resolve issues involving complex Healthcare EDI transactions while maintaining strict compliance with Medicare, Medicaid, and HIPAA standards.
Required Experience
Successful candidates will demonstrate:
Required
Minimum 5 years of Healthcare EDI production support experience.
Hands-on experience with the latest versions of TIBCO BusinessConnect (BC).
Hands-on experience with the latest versions of TIBCO BusinessWorks (BW).
Hands-on experience with the latest version of TIBCO Foresight.
Strong experience supporting Healthcare HIPAA ANSI X12 transactions.
Required expertise supporting 837 Healthcare Claims transactions.
Experience supporting 835, 270, 271, and 276 transaction sets.
Medicare and Medicaid EDI processing experience.
Healthcare claims reconciliation experience.
Experience troubleshooting production EDI environments.
Ability to work independently with minimal supervision in a high-volume production environment.
Strong analytical and problem-solving skills.
Excellent written and verbal communication skills.
Preferred
Experience supporting enterprise Healthcare integration environments.
Experience working directly with external trading partners and vendors.
Knowledge of Healthcare claims adjudication workflows.
SQL or scripting experience for production support and analysis.
Purpose
Your work directly supports the timely exchange of healthcare claims information that enables providers to be reimbursed accurately and members to receive uninterrupted healthcare services. Every successful transaction contributes to operational excellence and strengthens relationships with providers, members, and business partners.
This assignment provides the opportunity to deepen expertise in enterprise Healthcare EDI operations, TIBCO integration technologies, HIPAA X12 transactions, claims reconciliation, production support, and healthcare systems integration while supporting one of the organization's highest-volume operational environments.
This role is ideal for professionals who enjoy solving production issues, owning critical operational processes, working independently, and becoming the trusted technical expert responsible for ensuring enterprise Healthcare EDI systems remain stable, compliant, and highly available.
Objectives
1. Maintain Stable Healthcare EDI Production Operations
Within the first 30-60 days, assume ownership of daily Healthcare EDI production support activities utilizing the latest versions of TIBCO BusinessConnect (BC), BusinessWorks (BW), and Foresight. Monitor production processing, investigate rejected files, resolve transaction failures, coordinate vendor communications, and ensure all scheduled Medicare and Medicaid transactions process successfully within established service levels. Success will be measured through system availability, reduced processing failures, rapid issue resolution, and consistent operational performance. AI-assisted monitoring, log analysis, and documentation tools may be used where appropriate while ensuring all production decisions are validated according to healthcare compliance requirements.
2. Ensure Accurate Healthcare Claims Processing and Transaction Integrity
Support the reliable processing of Healthcare X12 transactions by validating transaction integrity, troubleshooting processing exceptions, supporting claims reconciliation, and ensuring compliance with HIPAA transaction standards. Primary responsibility will focus on high-volume 837 Healthcare Claims while also supporting 835 Remittance Advice, 270/271 Eligibility, and 276 Claim Status Inquiry transactions. Success will be measured through transaction accuracy, successful claims processing, reduced production defects, and stakeholder confidence in transaction quality.
3. Resolve Production Issues and Strengthen Trading Partner Relationships
Serve as the technical expert responsible for diagnosing, troubleshooting, and resolving Healthcare EDI production issues involving internal applications, external vendors, and trading partners. Manage rejected files, investigate processing failures, support testing activities, and communicate resolution status effectively to all stakeholders. Success will be measured through issue resolution time, reduced recurring incidents, successful testing outcomes, and improved trading partner satisfaction.
4. Improve Operational Readiness and Support Future Growth
Support the organization's expanding Healthcare EDI workload by improving operational documentation, testing procedures, monitoring practices, and production support processes. Identify opportunities to streamline workflows, improve transaction visibility, reduce recurring issues, and prepare the environment for continued growth through 2027. Success will be measured through improved operational efficiency, standardized support processes, reduced production interruptions, and successful support of increasing transaction volumes.
Critical Subtasks
1. Monitor and Support Daily Production Processing
Monitor inbound and outbound Healthcare EDI transactions throughout the day, investigate production alerts, resolve failed processes, and ensure all scheduled transaction processing completes successfully within required service levels.
2. Support TIBCO Integration Platforms
Maintain and troubleshoot Healthcare EDI integrations utilizing the latest versions of TIBCO BusinessConnect (BC), BusinessWorks (BW), and Foresight, ensuring stable connectivity, reliable message processing, transaction validation, and compliance with organizational integration standards.
3. Troubleshoot Healthcare X12 Transactions
Investigate rejected files, validation errors, transaction failures, and production issues involving Healthcare X12 transactions, with particular emphasis on 837 Healthcare Claims. Support additional transaction types including 835, 270, 271, and 276 while ensuring compliance with HIPAA standards.
4. Support Claims Reconciliation and Testing Activities
Participate in claims reconciliation, production testing, implementation validation, and system change verification activities to ensure new releases and production updates maintain transaction integrity and operational stability.
5. Coordinate Vendor and Trading Partner Communications
Respond to vendor inquiries, coordinate issue resolution activities, communicate production status, and collaborate with internal business teams and external trading partners to resolve processing issues efficiently.
6. Maintain Operational Documentation and Knowledge
Develop and maintain documentation covering production support procedures, transaction processing standards, troubleshooting techniques, testing activities, and recurring operational issues to improve team readiness and long-term supportability.
7. Continuously Evaluate and Integrate AI to Improve Performance
Within the first 90-180 days, evaluate opportunities to responsibly leverage AI to improve Healthcare EDI operations through automated log analysis, transaction monitoring, production documentation, issue classification, testing support, knowledge retrieval, and workflow automation. Pilot practical AI-enabled solutions that improve operational efficiency while ensuring all Healthcare EDI processing remains compliant with HIPAA, Medicare, Medicaid, and organizational governance requirements.
Definition of Success
At the conclusion of the engagement, this individual is recognized as the trusted technical owner of the Healthcare EDI production environment. Daily transaction processing is stable, production issues are resolved quickly, trading partner relationships are strong, Healthcare X12 transactions are processed accurately and compliantly, and the organization is well positioned to support its expanding Medicare and Medicaid workload through 2027.