ABOUT THIS POSITION
The Claim Data Integrity (CDI) Analyst is responsible for researching, analyzing, and resolving healthcare claim rejections, payer edits, and data integrity issues that impact claim acceptance and reimbursement. This role serves as a subject matter expert on payer requirements, claim transactions, and industry standards, working across multiple teams to identify root causes, implement scalable solutions, and improve claim quality. The CDI Analyst partners with internal stakeholders, payers, and trading partners to reduce avoidable rejections, enhance client-facing messaging, and improve clean claim performance across the Waystar platform.
WHAT YOU'LL DO
Essential Responsibilities
Claim Analysis & Resolution
· Research, analyze, and resolve claim rejections and payer responses.
· Interpret payer edits, rejection messages, and industry requirements to determine root causes and corrective actions.
· Provide timely updates to case owners and stakeholders throughout the resolution lifecycle.
· Contact payers, intermediaries, and trading partners to obtain clarification regarding rejection behavior and submission requirements.
Data Integrity & Edit Management
· Proactively map raw payer and intermediary rejection messages into clear, client-friendly responses.
· Identify trends and recurring issues impacting claim acceptance.
· Participate in payer rejection reviews and clean claim improvement initiatives.
· Review and validate claim-edit logic, payer requirements, and supporting documentation.
Cross-Functional Collaboration
· Partner with Client Support, Product, Engineering, Analytics, EDI, and Payer Connectivity teams to resolve complex claim issues.
· Provide subject matter expertise related to payer requirements, claim edits, and healthcare transaction standards.
· Support initiatives that improve claim automation, accuracy, and client outcomes.
Documentation & Reporting
· Review and maintain CDI-related documentation, knowledge articles, and operational procedures.
· Adhere to data handling, access, and governance standards when working with claim data, reports, and mapping files.
· Contribute to reporting, trend analysis, and operational improvement efforts as assigned.
WHAT YOU'LL NEED
Required Qualifications
· Bachelor's degree or equivalent combination of education and experience.
· Experience in healthcare revenue cycle, claims processing, EDI, clearinghouse operations, payer operations, or healthcare technology.
· Working knowledge of healthcare claim transactions and industry standards, including ANSI X12 transactions, 837 Professional and Institutional claims, 999 and 277 acknowledgements, and CMS claim submission requirements.
· Strong analytical and problem-solving skills.
· Excellent written and verbal communication skills.
· Ability to manage multiple priorities in a fast-paced environment.
· Proficiency with Microsoft Office applications, particularly Excel.
Preferred Qualifications
· Experience with payer edits, rejection management, or claim validation systems.
· Familiarity with healthcare coding systems, including ICD, CPT, HCPCS, and revenue codes.
· Experience with data analysis, reporting, or operational trend analysis.
· Knowledge of healthcare clearinghouse processes and payer connectivity workflows.
· Experience working with cross-functional technical and operational teams.
ABOUT WAYSTAR
Through a smart platform and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle.
Waystar’s healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. Waystar is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers. We are deeply committed to living out our organizational values: honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful, optimistic & fun.
Waystar products have won multiple Best in KLAS® or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book™ surveys since 2012. The Waystar platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visitwaystar.com or follow@Waystar on Twitter.
WAYSTAR PERKS
Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.