Senior EDI Business Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of the complete encounter data management processes to guarantee compliance with CMS and state Medicaid regulations.

• Gather, analyze, and validate encounter submissions to ensure they meet accuracy, completeness, and alignment with Service Level Agreements (SLAs).

• Assist in audit and regulatory reporting efforts by creating and sustaining documentation and validation frameworks.

• Design and uphold processes to extract and transform data from source systems into HIPAA X12 837P format for encounter submissions.

• Work collaboratively with account management, data, and operations teams to collect requirements, document workflows, and oversee vendor or client deliverables.

• Examine data to uncover trends, anomalies, and root causes, delivering actionable insights to enhance workflows and improve ETL efficiency.

• Suggest and implement process enhancements that boost scalability, accuracy, and compliance throughout encounter data workflows.

⛳️ Requirements

• A Bachelor’s degree or equivalent experience.

• Over 4 years of experience in healthcare technology, managed care, consulting, or a similar field concentrating on regulatory data exchange.

• Practical experience with HIPAA X12 837P Medicaid submissions.

• Knowledge of payer operations, claims processing, and encounter lifecycle management.

• Demonstrated ability to independently manage multiple projects, prioritize tasks efficiently, and adhere to tight deadlines.

• Strong analytical, problem-solving, and communication abilities.

• Highly self-reliant and detail-oriented, thriving in a fast-paced, dynamic environment.

🏝️ Benefits

• Competitive salary with annual bonus opportunities.

• Remote work with flexible hours.

• Comprehensive health, dental, and vision insurance.

• 401(k) plan with company match.

• Generous paid time off, 10 paid company holidays, and paid parental leave.

• Opportunities for career advancement within a mission-driven organization.