Waystar · 10 hours ago
Sr Enterprise Rules and Edits Consultant
Atlanta, GA
Full-time
Onsite
Senior Level, Lead/Staff
10+ years expWaystar is a company that helps providers simplify healthcare payments and improve financials throughout the revenue cycle. The Senior Consultant, Enterprise Rule & Edits position is responsible for establishing client payer edit configurations to ensure clients exceed clean claim targets and achieve high satisfaction with Waystar's processes.
FinanceHealth CarePaymentsSoftware
Responsibilities
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
Design new payer edits based on a new client’s payer mix and facility types
Subject matter expert in claim edits and payer policies
Advise onboarding clients on optimizing claim rules and edits to prevent rejections and denials while reducing pended claim volume
Participate in project scoping and planning to design a client-specific rule and edit recommendations
Partner with product and technology teams to prioritize and deliver new functionality to meet the rule, edit, and claims reporting needs of onboarding clients
Clearly communicate Waystar’s rule and edit capabilities and value to clients during implementation
Analyze previous vendor rule and edit configurations for parity, configure new rules and edits to fill any gaps
Analyze parallel testing results to identify differences in expected to actual results, design new system logic to address any gaps
Study trends in custom rule and report requests to prioritize for product enhancements
Serve as liaison to Product to implement needed enhancements
Other duties as assigned
Qualification
Required
10+ years of experience in a healthcare setting
Strength discussing both complex technical information and general revenue cycle operations
Exceptional organizational and analytical skills to manage multiple priorities and deliver timely and accurate results
Demonstrated problem solving and decision-making process
Proficient in research investigation
EDI 835/837/270/276/278, X12 structures, formats, and standards
Strong process orientation, problem solving & troubleshooting skills, and a firm commitment to quality
HIPAA regulation knowledge
Healthcare terminology
Proficient with Microsoft Office Suite
Good written and oral communication skills; team player
Experience with EDI and/or healthcare transactions required
Ability to travel up to 20%
Ability to communicate with all levels of hospital / physician business office personnel
Preferred
Experience with Epic, Cerner, eCW, Nextgen, Meditech and other PM/HIS systems
Certified medical coder (CPC, RHIT, CPB, CCS, etc)
Experience with Waystar EDI solutions
Benefits
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
Company
Waystar
Waystar is a technology platform that provides healthcare revenue cycle management solutions.
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
$2.12B2025-09-11Post Ipo Secondary· $709.2M
2025-05-13Post Ipo Secondary· $557M
2025-02-20Post Ipo Equity· $800M
Leadership Team
Steven M. Oreskovich
Chief Financial Officer
Ryan Ayres
VP Sales - Health Systems and Hospitals - Western Region
Recent News
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2026-01-23
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