Business Analyst

Title : Business Analyst

100% Remote

The candidate needs strong experience in healthcare EDI to bridge the gap between business stakeholders and technical teams. The BA will be responsible for gathering requirements, analyzing healthcare transaction workflows, and ensuring solutions meet compliance, operational, and business needs. The candidate must possess excellent written and verbal communication skills with the ability and collaborate effectively with domain and technical experts in the organization.

Key Responsibilities

Work with business stakeholders, product owners, and technical teams to gather and document requirements for EDI implementations.

Experience with Edifecs and other EDI Gateway platforms.

Analyze, define, and validate HIPAA X12 transactions (837, 835, 270 / 271, 276 / 277, 278, etc.).

Create and maintain BRDs, FRDs, user stories, process flows, and use cases.

Collaborate with architects and developers to ensure proper translation, mapping, and validation of EDI files.

Serve as liaison between business teams, trading partners, and IT teams during onboarding and integration.

Support UAT planning and execution, including test case creation and defect triage.

Ensure compliance with HIPAA, CMS, Medicaid, and Medicare regulations.

Participate in Agile ceremonies (backlog grooming, sprint planning, daily standups, retrospectives).

Provide operational and production support for EDI transaction issues.

Required Skills & Experience

8+ years of Business Analyst experience with at least 5+ years in healthcare EDI.

Strong knowledge of HIPAA X12 transactions (837 / 835 / 270 / 271 / 276 / 277 / 278).

Experience working with healthcare payers, providers, or clearinghouses.

Familiarity with EDI tools / platforms like Edifecs, Foresight.

Strong analytical and documentation skills (BRD, FRD, user stories, workflows).

Experience with SQL for data validation and analysis.

Excellent communication and stakeholder management skills.

Preferred Qualifications

Experience with Edifecs platform (Smart trading cloud platform, SpecBuilder, Transaction Manager, TPM, etc.).

Familiarity with claims adjudication systems (Facets, QNXT, Epic, etc.).

Knowledge of cloud data platforms, APIs.