Edi Business Rules Analyst

Key Responsibilities
Rules Design & Pre-Scrub Development
Develop and maintain EDI pre-scrub rules to validate and correct incoming/outgoing transactions before submission or processing.
Implement state-driven logic (Medicaid/state mandates, encounter requirements, formatting, code sets, timelines) and ensure compliance.
Build trading partner–specific edits (payer/state agencies/clearinghouses) including companion guide alignment and partner routing rules.
Translate business requirements into rules-based configurations and edits (reject, pend, auto-correct, reformat, enrich).
Impact Analysis & Change Delivery
Perform detailed impact assessments for new state requirements, partner changes, regulatory updates (ICD/CPT/HCPCS/NDC), and companion guide revisions.
Analyze upstream/downstream impacts across pre-scrub, translation/mapping, Facets processing, and outbound submissions.
Create/maintain rule catalogs, decision tables, and rule traceability (requirement → rule → test cases → results).