Enterprise Rules & Edits Analyst

ABOUT THIS POSITION Waystar is seeking a smart, technical and creative Enterprise Rules & Edits Analyst seeking a chance to grow their career and work with claim billing & coding/authorization rules. This analytical, solution-oriented individual will report to a Director of Enterprise Rules & Edits and work closely with client support and technology teams. This role will serve as an expert in government and payer requirements, focusing on how to help our clients improve clean claim rates and reduce denials against those constraints. WHAT YOU'LL DO This cross-functional position will work with product, client support and technical teams to deliver accurate, timely claim edit/authorization rule configurations. Studying healthcare industry standards and staying up-to-date on industry changes and compliance issues, focusing on government/payer requirements for claims billing & coding/authorization. Leverage analytical tools (Excel, PowerBI, SQL Databases) to identify trends and outliers in EDI 837/835/278 transaction data. Transform data into actionable claim edits, policy recommendations or authorization rule configurations. Configure system settings and options; plan and execute unit, integration and acceptance testing. Serve as a subject matter expert in medical billing and coding, authorization rules and requirements, EDI 835/837. Consult with high-value clients to optimize claim edit/authorization rule configurations. Develop sustainable processes and systems to ensure claim edits are accurately and efficiently maintained. WHAT YOU'LL NEED Bachelor’s degree or 2-4 years of equivalent experience in a healthcare setting. You know how to execute and like to roll up your sleeves to get things done. An understanding and knowledge of hospital revenue cycle workflows and the provider reimbursement process from patients and payers obtained either through direct experience in a healthcare setting or an RCM-focused HIT company. Problem solving skills; able to analyze a problem and design creative solutions. Possess planning and organization skills to independently develop and lead projects when applicable. Excellent written communication skills; able to succinctly convey complex ideas through writing. Flexible and agile; able to rapidly adapt to changing situations and inputs. Medical claims coding certification preferred. ABOUT WAYSTAR Through a smart platform and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle. Waystar’s healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. WAYSTAR PERKS Competitive total rewards (base salary + bonus, if applicable). Customizable benefits package (3 medical plans with Health Saving Account company match). We offer generous paid time off for our non‑exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays. We also offer flexible time off for our exempt team members + 13 paid holidays. Paid parental leave (including maternity + paternity leave). Education assistance opportunities and free LinkedIn Learning access. Free mental health and family planning programs, including adoption assistance and fertility support. 401(K) program with company match. Pet insurance. Employee resource groups. EEO Statement Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. #J-18808-Ljbffr