Business Analyst, Healthcare EDI

Employer Industry: Healthcare Services

• Salary up to $55 per hour
• Opportunity for career advancement and growth within the organization
• Work collaboratively with diverse teams in a supportive environment
• Chance to make a meaningful impact in the healthcare delivery system
• Engage in innovative projects related to eligibility and benefits transactions

• Own the end-to-end strategy for eligibility data presentation, including simplification of complex benefit structures
• Define the canonical internal data model for eligibility and benefit information across products and workflows
• Analyze 270/271 X12 files to document detailed parsing logic for eligibility and benefits segments
• Create and execute test cases for 270/271 flows, including positive/negative scenarios and regression testing
• Ensure compliance with HIPAA, payer companion guides, and CAQH CORE operating rules for eligibility transactions

• 3–5+ years of experience as an EDI Analyst, Business Analyst, or similar role in healthcare, with hands‑on work on ANSI X12 transactions
• Strong experience with 270/271 eligibility and benefits transactions, including reading raw X12 files
• Solid understanding of health insurance concepts such as plan types, covered services, and benefit limitations
• Experience creating functional specs, mapping documents, and business rules for EDI data integration
• Proficiency with advanced Excel and familiarity with SQL or similar tools for validating eligibility data

• 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 working 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

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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top‑tier employer.