Lead end-to-end encounter data management for CMS/state Medicaid submissions. Validate and optimize ETL converting source data into HIPAA X12 837P, support regulatory audits, analyze trends and root causes, liaise across business/technical/operations teams, and recommend process improvements to ensure compliance and data integrity.
About the Role
SafeRide Health is seeking a Sr. EDI Business Analyst to ensure the accuracy and completeness of healthcare encounter data submissions to CMS (Centers for Medicare & Medicaid Services). This role serves as the key liaison between business, technical, operations, and compliance teams, ensuring our encounter data management processes meet regulatory and client standards.
You’ll play a pivotal role in analyzing, validating, and optimizing data pipelines that support our mission of removing barriers to care for underserved populations. This is an opportunity to contribute to healthcare innovation while driving operational excellence and data integrity at scale.
Key Responsibilities
- Own end-to-end encounter data management processes to ensure compliance with CMS and state Medicaid guidelines.
- Compile, analyze, and validate encounter submissions to ensure accuracy, completeness, and alignment with Service Level Agreements (SLAs).
- Support audit and regulatory reporting initiatives by developing and maintaining documentation and validation frameworks.
- Develop and maintain processes to extract and transform data from source systems into HIPAA X12 837P format for encounter submissions.
- Collaborate cross-functionally with account management, data, and operations teams to gather requirements, document workflows, and oversee vendor or client deliverables.
- Analyze data to identify trends, anomalies, and root causes, providing actionable insights to optimize workflows and improve ETL efficiency.
- Recommend and implement process improvements that enhance scalability, accuracy, and compliance across encounter data workflows.
Required Qualifications
- Bachelor’s degree or equivalent experience, with 4+ years in healthcare technology, managed care, consulting, or a related field focused on regulatory data exchange.
- Hands-on experience with HIPAA X12 837P Medicaid submissions, including loop and segment structures, and regulatory reporting to CMS or state agencies.
- Understanding of payer operations, claims processing, and encounter lifecycle management.
- Proven ability to manage multiple projects independently, prioritize effectively, and meet tight deadlines.
- Strong analytical, problem-solving, and communication skills.
- Highly self-sufficient and detail-oriented, comfortable in a fast-paced, dynamic environment.
Preferred Qualifications
- Strong SQL and Excel skills, with familiarity in data visualization tools such as Tableau, Looker, or QuickSight.
- Client-facing experience working with healthcare payers, providers, or clearinghouses.
- Experience with Edifecs or similar EDI tools.
Benefits
- Competitive salary and annual bonus opportunities
- Remote with flexible hours
- Comprehensive health, dental, and vision insurance
- 401(k) with company match
- Generous PTO, 10 paid company holidays, and paid parental leave
- Career growth opportunities in a mission-driven organization
About SafeRide Health
SafeRide Health is a technology and services company committed to eliminating transportation barriers to healthcare. By combining our proprietary tech platform with a nationwide network of vetted transportation providers, we empower payers and health systems to deliver smarter, more reliable non-emergency medical transportation.
Our platform supports the nation’s largest Medicare Advantage, Medicaid, and provider programs—improving health outcomes and patient experiences at scale.
Learn more at www.saferidehealth.com.
Similar Jobs
Fintech • Information Technology • Insurance • Financial Services • Big Data Analytics
Leads enterprise data and analytics strategy, architecture, modernization, and delivery across cloud and on-premises environments. Oversees data platforms, engineering, integration, governance, quality, lineage, security, and compliance. Partners with executives to define roadmaps and investments, manages cross-functional teams and vendors, enables AI/ML capabilities, and mentors data professionals while driving scalable, trusted data solutions and measurable business outcomes.
Top Skills:
AgileSparkAzure Data PlatformCloud ComputingData GovernanceData LakesData LineageData WarehousingDatabricksMaster Data ManagementMetadata ManagementAzurePythonSQL
Fintech • Information Technology • Insurance • Financial Services • Big Data Analytics
Develops and maintains Access databases, SQL reports, Cognos and Power BI dashboards, SharePoint solutions, and operational workflows. Analyzes transactional, financial, staffing, productivity, and performance metrics; validates data; creates projections and regulatory reports; and presents findings to senior leadership. Partners with stakeholders and IT to gather requirements, improve processes, automate workflows, ensure data integrity, and support compliance and business operations.
Top Skills:
AlteryxCognosETLInfopathMicrosoft AccessPower BIPowerPointRSASSharepointSpssSQLSQL ServerSsisVBA
Fintech • Information Technology • Insurance • Financial Services • Big Data Analytics
Reviews medical insurance applications for group life and disability coverage, researches medical conditions and medications, orders additional medical documentation, and applies underwriting guidelines to approve, deny, or pend cases. Maintains quality and consistency across cases while communicating clearly, using multiple systems, incorporating feedback, and applying clinical expertise to business underwriting decisions.
Top Skills:
Ai ToolsExcelMS OfficeMicrosoft Word
What you need to know about the Colorado Tech Scene
With a business-friendly climate and research universities like CU Boulder and Colorado State, Colorado has made a name for itself as a startup ecosystem. The state boasts a skilled workforce and high quality of life thanks to its affordable housing, vibrant cultural scene and unparalleled opportunities for outdoor recreation. Colorado is also home to the National Renewable Energy Laboratory, helping cement its status as a hub for renewable energy innovation.
Key Facts About Colorado Tech
- Number of Tech Workers: 260,000; 8.5% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Lockheed Martin, Century Link, Comcast, BAE Systems, Level 3
- Key Industries: Software, artificial intelligence, aerospace, e-commerce, fintech, healthtech
- Funding Landscape: $4.9 billion in VC funding in 2024 (Pitchbook)
- Notable Investors: Access Venture Partners, Ridgeline Ventures, Techstars, Blackhorn Ventures
- Research Centers and Universities: Colorado School of Mines, University of Colorado Boulder, University of Denver, Colorado State University, Mesa Laboratory, Space Science Institute, National Center for Atmospheric Research, National Renewable Energy Laboratory, Gottlieb Institute
