Edifecs QA Analyst | USA Remote

Key Responsibilities

• Analyze HIPAA implementation guides and payer companion guides to develop comprehensive test scenarios.
• Create, maintain, and execute EDI test files covering positive, negative, and edge-case scenarios.
• Validate healthcare claims using Edifecs against HIPAA standards, SNIP levels, and payer-specific rules.
• Test EDI acknowledgments and responses to ensure accurate error reporting.
• Perform end-to-end claims testing, from EDI intake through claims processing and adjudication.
• Use SQL to validate claim data, mappings, and downstream processing results.

Required Skills

• Hands-on experience with Edifecs for healthcare EDI claims validation.
• mainframe
• Strong understanding of HIPAA EDI transactions and healthcare claims processing.
• Experience creating, reading, and modifying EDI test files.
• Knowledge of HIPAA SNIP validation levels and payer companion guides.
• Proficiency in SQL for backend data validation.
• Understanding of claims submission, adjudication, payment, and claim status workflows.