EDI & Claims Operations Analyst
New
J
JobgetherHealthcare Revenue Cycle
Fully remote opportunity within the United States.Full-TimeMiddle
Salary76,000 - 100,000 USD per year
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Job Details
- Experience
- 4+ years
- Required Skills
- SQLData AnalysisMicrosoft Power BIMicrosoft ExcelGoogle Sheets
Requirements
- Bachelor’s degree or equivalent combination of education and experience.
- 4+ years of healthcare revenue cycle experience.
- Demonstrated experience with claim submission, claim status management, and EDI operations.
- Strong understanding of healthcare claims workflows and payer processing.
- Proven ability to research and resolve claim transmission, acceptance, and rejection issues.
- Advanced Microsoft Excel or Google Sheets skills for data analysis and reporting.
- Strong analytical, investigative, and root-cause analysis abilities.
- Ability to work independently and manage complex issues across multiple teams.
- Excellent communication and stakeholder management skills.
- Experience with clearinghouse platforms (e.g., Change Healthcare, Waystar, Availity) is preferred.
- Knowledge of healthcare EDI transactions (837, 835) is preferred.
- Experience with analytical tools like Snowflake, Power BI, Tableau, or SQL is a plus.
Responsibilities
- Monitor claim status activity across clearinghouses and payer systems to ensure successful transmission and processing.
- Analyze large claim populations to identify trends, bottlenecks, and payer-specific workflow challenges.
- Investigate rejected, unacknowledged, or delayed claims to determine underlying root causes.
- Partner with cross-functional teams including Billing, Coding, Engineering, and Automation to resolve processing issues.
- Identify and implement opportunities to automate manual claim status workflows.
- Research payer-specific requirements and rejection patterns to improve claim acceptance rates.
- Track and communicate claim status performance metrics to operational leadership.
- Create process documentation and operational guidance to support standardized workflows.
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