EDI Business Analyst

Core Responsibilities

Requirement Engineering: Lead discovery sessions with clinical, billing, and network operations to map healthcare data pipelines.

Data Mapping & Design: Author detailed data mapping specifications converting legacy formats into modern cloud data lake models

Databricks Collaboration: Partner with data engineers to translate business logic into optimized PySpark or SQL transformation pipelines

Standards Enforcement: Serve as the subject matter expert for healthcare data exchange compliance across all internal platforms.

Testing & Validation: Define comprehensive test scenarios, validate complex payloads, and coordinate End-to-End user acceptance testing.

Technical Qualifications:

EDI X12 Expertise: Advanced proficiency in processing and translating 837 (Claims), 834 (Enrollment), 835 (Remittance), and 270/271 (Eligibility) files - 8+ years of experience

Databricks Ecosystem: Strong familiarity with Delta Lake concepts, Medallion Architecture (Bronze/Silver/Gold), and Unity Catalog governance - 6+ years of experience

Data Querying: Exceptional SQL skills to analyze multi-million row datasets, write complex joins, and audit pipeline data quality - 6+ years of experience

Interoperability Standards: Deep working knowledge of CMS Interoperability rules, HL7 v2/v3, and FHIR resource structures.

Payer Operations: Direct experience working within a health plan environment, including strong grasp of claims pricing and enrollment logic.

Soft Skills & Professional Experience

Experience: Minimum 8+ years of IT Business Analysis experience, with at least 4 years dedicated to healthcare interoperability.

Agile Delivery: Proven success operating in fast-paced Scrum or Kanban environments, owning Jira epics and story decomposition.

Bridging the Gap: Rare ability to explain highly complex X12 looping structures to developers, and technical Databricks limitations to business stakeholders.