Essen Health Care · 1 hour ago
Business Analyst, Healthcare EDI
United States
Full-time
Remote
Mid, Senior Level
$45/hr - $55/hr
3+ years expEssen Health Care is the largest privately held multispecialty medical group in the Bronx, dedicated to providing accessible and high-quality medical care. The Healthcare EDI Business Analyst will analyze ANSI X12 270/271 eligibility and benefits transactions, define business requirements, and design strategies for presenting coverage data to end users.
Health CareMedical
Responsibilities
Owns the end-to-end strategy for eligibility data presentation, including which EB segments to surface, how to rank conflicting benefits, and how to simplify complex benefit structures for front-line users
Defines the canonical internal data model for eligibility and benefit information used across products and workflows
Lead discovery with revenue cycle, registration, and clinical stakeholders to define how eligibility, copay, deductible, coinsurance, and plan limitations should appear in eCares portal and/or PMS/EHR screens, and reports
Analyze 270/271 X12 files (loops, segments, codes) to document detailed parsing logic for EB, DTP, AMT, HSD and related segments covering benefit levels, service types, and financial accumulators
Translate business needs into functional and mapping specifications for engineering or integration teams, including data dictionaries, field-level requirements, and error-handling rules
Define and maintain business rules to normalize and prioritize multiple EB segments (e.g., selecting primary copay/coinsurance for office visits vs. surgery vs. preventive services)
Design and document UI/UX guidelines for displaying eligibility data (e.g., base/remaining deductible, OOP, copay by service type) consistent with CAQH CORE 270/271 data content rules
Partner with EDI and infrastructure teams to support connectivity, trading partner onboarding, and monitoring of 270/271 transactions, including handling rejections and AAA error segments
Create and execute test cases for 270/271 flows, including positive/negative scenarios, regression testing, and validation against companion guides and CORE rules
Work with data/BI teams to define and validate downstream use of eligibility data for dashboards and analytics (e.g., eligibility hit rate, verification timeliness, estimated patient responsibility)
Document current and future state eligibility workflows, process maps, and standard operating procedures for front-end staff and revenue cycle teams
Ensure compliance with HIPAA, payer companion guides, and CAQH CORE operating rules for eligibility and benefits transactions
Provide subject matter expertise and training to product, operations, and support teams on interpreting 270/271 responses and resolving eligibility-related issues
Qualification
Required
3–5+ years of experience as an EDI Analyst, Business Analyst, or similar role in healthcare, with hands-on work on ANSI X12 transactions
Strong, demonstrable experience with 270/271 eligibility and benefits transactions, including reading raw X12 files and understanding loops (2000, 2100, 2110) and EB/EQ segments
Solid understanding of health insurance concepts: plan types, covered services, service types, payer types, primary & secondary plans, HMOs, copay, coinsurance, deductibles, OOP maximums, accumulators, and benefit limitations
Experience creating functional specs, mapping documents, and business rules for parsing and integrating EDI data into PMS/EHR, clearinghouse, or custom applications
Proficiency with advanced Excel and familiarity with SQL or similar tools for validating and profiling eligibility data
Knowledge of HIPAA transaction standards and CAQH CORE eligibility & benefits rules
Strong communication skills and ability to translate technical EDI content into clear requirements and user-facing documentation
Preferred
Experience in provider revenue cycle, registration, scheduling, or prior authorization operations
Prior work with payer or clearinghouse 270/271 companion guides and real-time eligibility APIs
Background working in Agile product teams, writing user stories and acceptance criteria for eligibility features
Exposure to other HIPAA X12 transactions (835, 837, 276/277, 834) to understand end-to-end data flow
Company
Essen Health Care
Essen Health Care is a premiere healthcare network in New York with over 400 providers across Manhattan, Bronx, Queens, Staten Island, Long Island and Westchester County.
501-1000 employees
H1B Sponsorship
Essen Health Care has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (34)
2023 (12)
2022 (12)
2021 (49)
2020 (25)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Kain Capital
2024-04-30Private Equity
Leadership Team
Durga Dhanikonda
Chief Information Security & Technology Officer (CISO & CTO)
Ranjan Munjal
Chief Financial Officer
Recent News
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