Lead II: Healthcare EDI Business Analyst

The Lead II – Business Analyst plays a critical role in bridging the gap between business stakeholders and technical teams within a leading healthcare organization.

The ideal candidate will have extensive experience in healthcare EDI and strong analytical, documentation, and communication skills.

This role involves gathering requirements, analyzing healthcare transaction workflows, ensuring regulatory compliance, and supporting solution delivery that meets operational and business needs.

Key Responsibilities

• Work with business stakeholders, product owners, and technical teams to gather and document requirements for EDI implementations.
• Analyze, define, and validate HIPAA X12 transactions (837, 835, 270/271, 276/277, 278, etc.).
• Collaborate with architects and developers to ensure accurate translation, mapping, and validation of EDI files.
• Create and maintain BRDs, FRDs, user stories, process flows, and use cases.
• 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.
• Contribute to sprint planning and estimation by identifying dependencies and constraints from a business perspective.
• Develop effective requirement creation and management practices, aligning designed and delivered solutions with stakeholder needs.
• Champion requirements elicitation using techniques like interviews, workshops, surveys, document analysis, and use cases.
• Support the team through effective communication, stakeholder collaboration, and decision-making.
• Drive adoption of tools, templates, and processes that improve efficiency in business analysis and stakeholder engagement.
• Conduct training sessions and workshops to grow and develop the BA community within the organization.

• 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 such as Edifecs and 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.
• Proficiency in analytical thinking, problem solving, and decision-making.
• Strong understanding of software development life cycle and Agile methodologies.
• Expertise in developing process flow diagrams, use cases, and functional/technical requirements in the form of user stories.
• Advanced knowledge of various BA techniques such as business case development, prototyping, process modeling, root cause analysis, and risk assessment.

• Experience with Edifecs platform (Smart Trading Cloud, SpecBuilder, Transaction Manager, TPM, etc.).
• Familiarity with claims adjudication systems (Facets, QNXT, Epic, etc.).
• Knowledge of cloud data platforms and APIs.
• Advanced understanding of business analysis frameworks (such as IIBA-recommended knowledge areas).
• Experience in defining performance measures and assessing solution effectiveness.
• Strong interpersonal skills for stakeholder engagement and conflict resolution.
• Demonstrated ability to identify and drive process improvement opportunities.