EDI ANALYST - REMOTE - PALCO : Job Details

EDI ANALYSTPalco is a visionary company pioneering an emerging health-care movement that empowers people with disabilities and those aging to live independent and quality lives. Made possible by our amazing team, Palco provides technology and financial services to aid individuals and their families to thrive in their home and communities. Partnered with government agencies and fortune 500 managed care organizations across the country, we are dedicated to creating exceptional outcomes for our clients and the millions of people that count on them. We are a highly organized company that offers a solid work/life balance, autonomy, generous paid time off, bonus potential, and career advancement opportunities. Our staff make long-lasting impact on the lives of people every day. The EDI Analyst designs and implements the EDI data flow between Palco, partner and customer applications, and also ensures robust billing & payroll systems processing. Reporting to the Product Management leader, the Analyst facilitates new program onboarding, existing program operations and internal application enhancements accurately and on-time. Owning and supporting financial and Medicaid claims data ingestion, distribution and transmission, the Analyst will provide ongoing guidance and decision support to leadership, using EDI/Database analysis expertise and critical thinking skills. Duties and Responsibilities

• Strong understanding of how data moves between systems, including integration points, workflows, and data transformation.
• Experience with billing transactions and X12 EDI files, including but not limited to 837 (claims), 276/277 (claims status inquiry/response), 824 (application reporting), and 270/271 (eligibility files).
• In-depth knowledge of healthcare industry rules, including compliance with HIPAA and other relevant regulations.
• Familiarity and configuration experience with accounting information systems and general accounting functions, such as accounts payable, receivable, and payroll processing.
• Ability to analyze, interpret, and present data to support decision-making across multiple teams.
• Strong ability to troubleshoot and resolve data discrepancies and system integration issues.
• Ability to work closely with technical, billing, and accounting teams to ensure seamless data flow and accurate financial reporting.
• Highly detail-oriented with a focus on data accuracy and process efficiency.
• Participates in new program onboarding to gather and document requirements related to self-directed Medicaid plan participant data extract, transform and load (ETL). This may involve a variety of formats and protocols, such as EDI, XML, JSON, etc.
• Plans implementation projects with specific steps for discovering requirements; mapping data elements; requesting changes to the Palco database and accounting system; developing connectivity and document test protocols; coordinating with third parties; and testing and successfully implementing projects.
• Troubleshoots data transmission issues that affect payroll and medical claims, understands and documents reasons for rejection, and works with internal and external teams to correct these, as well as prevent future issues.
• Acts as a subject matter expert and owner for data exports and imports to and from the company's applications, accounting system, reporting warehouses and HIPPA Suite. Expert in eligibility checks and PII/PHI. Supports secure payroll processing efficiency and tax reporting.
• Perform duties in compliance with all standards and laws, such as HIPPA and GAAP.

Experience and Skills

• Expertise in a variety of data exchange formats and protocols, such as ANSI ASC X12; EDI 270, 271, 276, 277, 820, 834, 835, 837; XML; REST; JSON; etc.
• Understands basic accounting, tax, payroll, payment, remittance, and billing processes, as well as enabling software
• Knowledge of PII, PHI, HIPPA, Medicaid, and accounting-related compliance and internal controls
• Strong acumen to gather and write business requirements for any audience, i.e., external customers, internal development teams - balancing specificity and conciseness
• Command of project management principles and practices, with expertise communicating clear steps, timelines, dependencies and risks with mitigation and contingency strategies
• Leadership and facilitation of internal and external meetings with excellent planning; agenda communication; follow-up action items, owners, and timelines. Participates as a subject matter expert when attending others' meetings.
• Ability to visually represent processes using MS PowerPoint, Visio and other tools
• Familiarity with Atlassian Confluence, JIRA, Trello, Mural and other collaboration tools
• Experience with HIPPA Suite or similar EDI file parsing tools, and experience writing queries to extract relevant data for use in Palco systems and applications. Prior experience with EasyMorph software a plus.

Education and Qualifications

• Bachelor's degree (B.A. or B.S.) or equivalent and four years related experience in computer science or a related field
• Minimum of four years of experience in EDI and data analysis
• Strong financial, tax, healthcare insurance or medical accounting industry experience preferred
• Familiarity or certification in Agile frameworks helpful
• Excellent PC Skills - must be proficient with MS Office Suite (Word, Excel, Outlook, PowerPoint)
• Excellent oral and written communication skills
• Must be able to work in a fast-paced and deadline-driven environment and work minimal overtime when needed
• Must have good organizational and interpersonal skills, strong attention to detail and work independently under tight deadlines
• Must have strong analytical and critical thinking skills

Palco, Inc. is an Equal Employment Opportunity (EEO) employer and does not discriminate in any employer/employee relations based on race, color, religion, sex, sexual orientation, gender identity and expression, national origin, age, marital status, disability, veteran status, genetic information or any other basis.