EDI and Interoperability Analyst PCHP

EDI Interoperability Analyst

Responsible for the design, implementation, maintenance, and monitoring of electronic data interchange (EDI) and healthcare interoperability processes to ensure secure, accurate, and timely exchange of healthcare data between Parkland Community Health Plan (PCHP) and internal or external partners. This role supports payer operations by managing standardized healthcare transactions, APIs, and interfaces in compliance with HIPAA, CMS, and state-specific requirements. The analyst collaborates closely with internal IT teams, vendors, clearinghouses, and business stakeholders to ensure continuity of operations, data integrity, and regulatory compliance across all interoperability workflows.

Education

Bachelor's degree in Computer Science, Information Systems, Health Information Management, or a related discipline.

Experience

• Three (3) years of experience supporting EDI, healthcare interoperability (HL7/FHIR), or data integration solutions in a production environment
• Three (3) years of experience supporting HIPAA transaction sets (834, 837, 835, 820, 999/277CA)
• Three (3) years of experience troubleshooting EDI transaction failures, reconciliation issues, and partner connectivity problems. Experience working in a healthcare payer, managed care organization, or healthcare IT environment.
• Experience using Fortra GoAnywhere MFT or MoveIT is a plus !

Equivalent Education and/or Experience

• Seven (7) additional years of progressively responsible healthcare EDI or interoperability experience may be considered in lieu of a degree.

Certification/Registration/Licensure

• Licenses/Certification(s)/Registration(s) (Preferred):
• EDI or Healthcare Interoperability certification (e.g., HL7)
• HIPAA or Healthcare Compliance training/certification (will be obtained at Parkland)
• Project Management training or certification (PMP preferred)

Skills / Abilities

• Adept at problem solving and decision making skills
• Adept at collaboration and teamwork
• Adept at growth mindset (agility and developing yourself and others) skills
• Adept at execution and delivery (planning, delivering, and supporting) skills
• Adept at business intelligence
• Adept at digital literacy skills

Responsibilities

• Acts as a specialist in data pipeline development, ensuring scalable, reliable, and secure integration of healthcare data across systems.
• Designs, implements, and supports EDI and interoperability solutions for healthcare transactions
• Maintains EDI environments, partner integrations, and secure data exchange processes
• Monitors daily EDI transaction flows and ensures timely resolution of rejected, failed, or suspended files
• Troubleshoots and resolves EDI, connectivity, and data validation issues in collaboration with internal teams, vendors, and trading partners
• Ensures compliance with HIPAA, CMS, and state regulatory requirements for all data exchanges
• Coordinates onboarding, testing, and certification of new trading partners and interfaces
• Participates in system upgrades, regulatory changes, and new regulatory mandates impacting interoperability
• Provides on-call or after-hours support for critical EDI cycles as required
• Documents operating procedures, mappings, companion guides, and support runbooks
• Identifies opportunities to improve data exchange reliability, automation, and monitoring
• Collaborates with analytics, claims, enrollment, and provider teams to support business operations

Job Accountabilities

• Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
• Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
• Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.