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Business Analyst, Healthcare EDI
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Job Description
- Req#: 2059
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $55 per hour
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on eligibility verification processes
- Work with a team dedicated to improving healthcare delivery for vulnerable populations
What to Expect (Job Responsibilities):
- Own the end-to-end strategy for presenting eligibility data, including simplifying complex benefit structures
- Define the internal data model for eligibility and benefit information used across products and workflows
- Lead discovery sessions with stakeholders to determine how eligibility and benefit information is displayed
- Analyze 270/271 X12 files to document parsing logic for eligibility and benefit segments
- Ensure compliance with HIPAA and CAQH CORE operating rules for eligibility and benefits transactions
What is Required (Qualifications):
- 3-5+ years of experience as an EDI Analyst, Business Analyst, or similar role in healthcare, with hands-on experience in ANSI X12 transactions
- Strong experience with 270/271 eligibility and benefits transactions, including understanding of raw X12 files and relevant segments
- Solid understanding of health insurance concepts such as plan types, covered services, and benefit limitations
- Experience creating functional specifications and mapping documents for EDI data integration
- Proficiency with advanced Excel and familiarity with SQL or similar tools for validating eligibility data
How to Stand Out (Preferred Qualifications):
- Experience in provider revenue cycle, registration, scheduling, or prior authorization operations
- Prior work with payer or clearinghouse 270/271 companion guides and real-time eligibility APIs
- Background in Agile product teams, writing user stories and acceptance criteria for eligibility features
- Exposure to other HIPAA X12 transactions to understand end-to-end data flow
#HealthcareServices #EDI #BusinessAnalyst #CareerOpportunity #EligibilityVerification
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