Senior EDI Business Analyst (Healthcare)

TL;DR

Senior EDI Business Analyst (Healthcare): Managing end-to-end encounter data submissions to CMS and state Medicaid agencies with an accent on HIPAA X12 837P compliance and data integrity. Focus on optimizing data pipelines, performing root cause analysis on claims data, and collaborating cross-functionally to ensure regulatory standards are met.

Location: Must be based in the United States

Company

hirify.global is a technology and services company dedicated to eliminating transportation barriers to healthcare by connecting payers and health systems with a nationwide network of transportation providers.

What you will do

• 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 SLAs.
• Develop and maintain processes to extract and transform data into HIPAA X12 837P format.
• Support audit and regulatory reporting initiatives by developing validation frameworks.
• Collaborate with account management, data, and operations teams to gather requirements and document workflows.
• Analyze data to identify trends and anomalies, providing actionable insights to improve ETL efficiency.

Requirements

• Must be based in the United States
• Bachelor’s degree or equivalent experience with 4+ years in healthcare technology, managed care, or regulatory data exchange.
• Hands-on experience with HIPAA X12 837P Medicaid submissions, including loop and segment structures.
• Understanding of payer operations, claims processing, and encounter lifecycle management.
• Proven ability to manage multiple projects independently and meet tight deadlines.

Nice to have

• Strong SQL and Excel skills with familiarity in data visualization tools like Tableau, Looker, or QuickSight.
• Client-facing experience working with healthcare payers, providers, or clearinghouses.
• Experience with Edifecs or similar EDI tools.

Culture & Benefits

• Competitive salary and annual bonus opportunities.
• Comprehensive health, dental, and vision insurance.
• 401(k) with company match.
• Generous PTO, 10 paid company holidays, and paid parental leave.
• Flexible remote work environment.