Healthcare Business Analyst - EDI/ HL7

• Analyze, document, and translate business requirements into functional requirements for healthcare EDI initiatives.
• Work with business and technical teams to define EDI workflows, business rules, transaction requirements, mappings, and acceptance criteria.
• Analyze and support HIPAA X12 transactions, including:
• 834 - Enrollment
• 837P / 837I - Claims
• 835 - Electronic Remittance
• 270/271 - Eligibility & Benefits
• 276/277 - Claim Status
• 278 - Authorization
• 999 / 277CA - Transaction Acknowledgments
• Review EDI implementation guides, companion guides, mapping specifications, and transaction requirements.
• Analyze inbound and outbound EDI transactions to identify mapping, data, validation, formatting, and business-rule issues.
• Perform root-cause and impact analysis for EDI defects and production issues.
• Partner with integration and technical teams to troubleshoot failed, rejected, or incorrectly processed EDI transactions.
• Create and maintain BRDs, FRDs, user stories, process flows, business rules, mapping documentation, and acceptance criteria.
• Own or support UAT, including test scenarios, test cases, test scripts, defect tracking, regression testing, and validation of fixes.
• Coordinate with QA, developers, EDI teams, operations, and business users to drive defects through resolution.
• Support EDI implementations, enhancements, migrations, releases, and production deployments.
• Work with payer, provider, clearinghouse, and trading-partner teams to resolve EDI issues and validate transaction processing.
• Participate in Agile ceremonies, requirements sessions, backlog refinement, status meetings, and production-support activities.
• Track requirements, user stories, defects, and project activities using JIRA and Confluence.
• Communicate complex EDI and healthcare data issues clearly to technical and non-technical stakeholders.

• 7-10+ years of experience as a Business Analyst, Senior Business Analyst, Business Systems Analyst, or similar role.
• Strong hands-on experience with Healthcare EDI / HIPAA X12.
• Strong knowledge of multiple healthcare EDI transactions, particularly 834, 837, 835, 270/271, 276/277, and 278.
• Strong understanding of X12 5010 standards and healthcare EDI workflows.
• Experience reviewing implementation guides, companion guides, mapping documents, and transaction specifications.
• Strong experience gathering and documenting business and functional requirements.
• Hands-on experience with UAT, test cases, test scripts, defect management, and regression testing.
• Experience troubleshooting EDI issues and performing root-cause and impact analysis.
• Experience supporting healthcare payer, claims, enrollment, eligibility, authorization, or remittance processes.
• Experience working with cross-functional business and technical teams.
• Experience with JIRA and Confluence.
• Excellent analytical, documentation, communication, and stakeholder-management skills.
• Experience working with Medicare, Medicaid, CMS, or commercial health plans.
• Experience with healthcare interoperability and data exchange.
• Exposure to FHIR, REST/SOAP APIs, JSON, or web services.
• Experience with Postman or similar API testing tools.
• Experience with healthcare EDI/integration platforms such as Edifecs, TIBCO, IBM Transformation Extender (ITX), HIPAA gateways, or similar technologies.
• Experience with healthcare payer platforms such as Facets, QNXT, TriZetto, or similar systems.
• Experience working with clearinghouses and external trading partners.
• Experience supporting EDI migrations, implementations, upgrades, and production releases.
• Experience working in Agile/Scrum and/or Waterfall environments., Acceptance Testing, Agile Programming Methodologies, Analysis Skills, Application Programming Interface (API), Artificial Intelligence (AI), Atlassian JIRA, Backlog Prioritization, Biotech and Pharmaceutical, Bug Tracking/Defect Management, Business Analysis, Business Solutions, Centers for Medicare and Medicaid Services (CMS), Consulting, Cross-Functional, Data Mapping, Data Quality, Documentation, Electronic Data Interchange (EDI), Functional Requirements Document (FRD), HIPAA (Health Insurance Portability and Accountability Act), HL7 (Health Level 7), Health Plan, Healthcare, IBM Product Family, Identify Issues, Interoperability, JSON, Mail Services, Medicaid, Medicare, Problem Solving Skills, Process Flow, Production Support, Quality Assurance, REST (Representational State Transfer), Regression Testing, Requirements Management, SOAP (Simple Object Access Protocol), Scrum Project Management and Software Development, Short Messaging Service (SMS), Systems Analysis, TIBCO Product family, Test Case, Test Scenario, Test Scripts, Test Tools, Track Customer Issues, Transaction Processing/Management, Validation Testing, Web Services

Pay Range: $40 - $55/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)

Our client is a leading Biotechnology Research Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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