EDI Business Analyst
On-siteMiami, Florida, United States
Job Summary
Design, implement, support, and validate practice and provider constructs within the clearinghouse while monitoring data feeds to identify and correct systemic risks before they impact claims or revenue. Research industry changes and data sets, analyze trends, and lead gap and issue analyses to develop optimization strategies for business processes. Conduct system and user acceptance testing, manage project plans, and maintain documentation to ensure solutions meet requirements. Collaborate with RCM leadership, stakeholders, and the clearinghouse partner to gather insights, present findings, and refine policies. Perform root-cause assessments and adapt documentation to address claim-editing, fee-schedule, and regulatory changes.
Required Qualifications
- Deep knowledge and understanding of professional claims processing and adjudication in the healthcare and health insurance industry
- Well-versed in revenue cycle management compliance, claim edits, rejections, and loop and segment errors
- Demonstrated knowledge of EDI document types, including 837, 277CA, 834, 835, TA1, 999, 820, and NCPDP D.0
- Superior analytical and conceptual thinking skills
- Strong technical skills
- Strong planning, organizational, and time-management skills
- Excellent verbal and written communication and documentation skills
- Advanced proficiency with Microsoft applications, including Word, Excel, and Outlook
- Maintains strict confidentiality and full HIPAA compliance
- Collaborative, dependable, and adaptable to changing priorities and workflows
- Bachelor's degree in health information management, business, information systems, or a related field, or an equivalent combination of education and experience
- 5+ years of experience as a business analyst or EDI analyst in a healthcare practice setting
- Experience with eClinicalWorks or a comparable practice management/EHR system
- Experience with pediatric or multi-specialty, multi-entity billing environments
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