Senior EDI Business Analyst
New
J
JobgetherHealthcare Technology
Based in United StatesFull-TimeSenior
Salary not disclosed
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Job Details
- Experience
- 4+ years
- Required Skills
- SQLTableauMicrosoft ExcelLooker
Requirements
- Bachelor's degree or equivalent professional experience.
- 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.
- 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.
Responsibilities
- 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.
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