Senior EDI Business Analyst

Accountabilities

• Oversight of encounter data management processes, ensuring regulatory compliance while improving data quality, operational efficiency, and collaboration across multiple teams.
• Own and manage end-to-end healthcare encounter data submission processes in accordance with CMS and state Medicaid requirements.
• Compile, analyze, validate, and monitor encounter submissions to ensure accuracy, completeness, and compliance with established service level agreements.
• Develop, maintain, and enhance documentation, validation procedures, and reporting frameworks to support audits and regulatory initiatives.
• Design and optimize processes for extracting, transforming, and formatting healthcare data into HIPAA X12 837P encounter files.
• Collaborate with business, operations, technical, and account management teams to gather requirements, document workflows, and coordinate deliverables.
• Analyze large datasets to identify trends, anomalies, and root causes, providing recommendations that improve ETL processes and operational performance.
• Recommend and implement process improvements that enhance scalability, compliance, data quality, and workflow efficiency.
• Support continuous improvement initiatives that strengthen healthcare data governance and regulatory reporting capabilities.

Requirements

• Strong healthcare EDI expertise with analytical skills and the ability to manage complex data workflows in a fast-paced environment.
• Bachelor's degree or equivalent professional experience, with 4+ years of experience in healthcare technology, managed care, consulting, regulatory reporting, or a related field.
• Hands-on experience working with HIPAA X12 837P Medicaid encounter submissions, including loop and segment structures.
• A strong understanding of CMS regulations, Medicaid encounter reporting, payer operations, claims processing, and encounter lifecycle management.
• Experience managing multiple projects simultaneously while meeting deadlines and maintaining high-quality deliverables.
• Excellent analytical, problem-solving, organizational, and communication skills.
• Detail-oriented, self-motivated, and capable of working independently in a dynamic remote environment.
• Strong SQL and Microsoft Excel skills.
• Familiarity with business intelligence and visualization tools such as Tableau, Looker, or Amazon QuickSight is preferred.
• Experience working directly with healthcare payers, providers, or clearinghouses is an advantage.
• Knowledge of Edifecs or other EDI management platforms is preferred.

Benefits

• Competitive salary with annual bonus opportunities.
• Flexible remote work environment with flexible scheduling.
• Comprehensive medical, dental, and vision insurance.
• 401(k) retirement plan with company matching.
• Generous paid time off.
• Paid parental leave.
• Career development and growth opportunities within a mission-driven organization.
• Opportunity to contribute to meaningful healthcare innovation and improve access to care.