Senior EDI Business Analyst

As a Senior EDI Business Analyst, you will oversee 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

The ideal candidate combines 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.
• 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.

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.
• 10 paid company holidays.
• 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.