Senior EDI Business Analyst

Job Summary

To ensure the accuracy and completeness of healthcare encounter data submissions to CMS, the full-time Senior EDI Business Analyst will manage end-to-end encounter data processes, analyze and validate submissions, and support audit initiatives while working remotely.

Key Responsibilities

• Own end-to-end encounter data management processes to ensure compliance with CMS and state Medicaid guidelines
• Compile, analyze, and validate encounter submissions to ensure accuracy, completeness, and alignment with Service Level Agreements (SLAs)
• Support audit and regulatory reporting initiatives by developing and maintaining documentation and validation frameworks

Required Qualifications

• Bachelor's degree or equivalent experience, with 4+ years in healthcare technology, managed care, consulting, or a related field focused on regulatory data exchange
• Hands-on experience with HIPAA X12 837P Medicaid submissions, including loop and segment structures, and regulatory reporting to CMS or state agencies
• Understanding of payer operations, claims processing, and encounter lifecycle management
• Proven ability to manage multiple projects independently, prioritize effectively, and meet tight deadlines
• Strong analytical, problem-solving, and communication skills