Healthcare NSA Analyst

Position : Healthcare NSA Analyst
Location : Remote
Duration : 1+ year

Job Summary

• We are seeking a detail-oriented Healthcare NSA (No Surprises Act) Analyst to support compliance and claims resolution processes related to federal No Surprises Act requirements. The ideal candidate will bring strong local claims processing knowledge, hands-on EDI experience, and a solid understanding of Blue Card and HRP-to-TPA workflows to ensure accurate, compliant, and timely claims handling.

Key Responsibilities

• Review, process, and analyze claims impacted by the No Surprises Act (NSA), ensuring compliance with federal regulations and payer-specific requirements
• Apply local claims processing knowledge within HRP (Health Rules Payer) to identify, research, and resolve claim discrepancies
• Analyze and troubleshoot EDI transactions, with particular focus on 837 (claims submission) files, identifying and correcting errors or rejections
• Support Blue Card claims processing, coordinating between local plans and host/home plans as needed
• Manage and understand HRP-to-TPA (Third Party Administrator) workflows, ensuring accurate data exchange and claims handoff between systems
• Investigate and resolve claim pricing, adjudication, and payment issues related to NSA-eligible services
• Collaborate with cross-functional teams (claims, compliance, IT/EDI, provider relations) to identify root causes of processing issues and recommend solutions
• Maintain documentation of NSA-related claims decisions, workflows, and process improvements
• Monitor regulatory updates related to the No Surprises Act and assess impact on internal processes
• Support audits, reporting, and quality assurance related to NSA claims compliance

Required Qualifications

• Experience with local claims processing in HRP (Health Rules Payer) or similar claims platform
• Hands-on experience with EDI files, specifically 837 transactions
• Working knowledge of Blue Card processes and/or HRP-to-TPA workflows
• General healthcare industry knowledge, including claims lifecycle, adjudication, and payer/provider relationships
• Strong analytical and problem-solving skills
• Ability to interpret regulatory requirements (No Surprises Act) and translate them into operational processes
• Excellent attention to detail and organizational skills
• Strong written and verbal communication skills