Enterprise Rules & Edits Analyst

ABOUT THIS POSITION

Waystar is seeking a curious, technical, and solutions‑oriented Enterprise Rules & Edits Analyst who’s eager to deepen their expertise in claim billing, coding, and authorization rules. In this role, you’ll translate complex payer and government requirements into accurate, high‑performing claim edits and authorization logic that help our clients improve clean claim rates and reduce denials.
You’ll report to the Manager of Enterprise Rules & Edits and work closely with client support, product, and technology teams. This role is ideal for someone who enjoys digging into data, solving operational puzzles, and building scalable rules that drive measurable impact.

WHAT YOU'LL DO

Rule Development & Configuration

• Build, validate, and deploy claim edit and authorization rule configurations with accuracy and efficiency.
• Configure system settings and options; plan and execute unit, integration, and acceptance testing.
• Translate payer and government requirements into structured, maintainable rule logic.

Industry & Compliance Expertise

• Stay current on healthcare billing, coding, and authorization requirements, with a focus on government and payer policies.
• Interpret regulatory updates and convert them into actionable rule changes or recommendations.

Data Analysis & Insights

• Use analytical tools (Excel, Power BI, SQL databases) to identify trends, anomalies, and root causes in EDI 837/835/278 data.
• Transform data findings into optimized claim edits, policy recommendations, or rule enhancements.

Client & Cross‑Functional Collaboration

• Serve as a subject matter expert in medical billing, coding, authorization workflows, and EDI transactions.
• Partner with high‑value clients to refine and optimize their claim edit and authorization rule configurations.
• Collaborate with client support, product, and technology teams to ensure rule accuracy, scalability, and long‑term maintainability.

Process Improvement & Governance

• Develop sustainable processes and documentation to ensure claim edits and rules are consistently maintained and updated.
• Create clear, comprehensive rule specifications, testing artifacts, and operational documentation.
• Identify opportunities to streamline workflows, strengthen rule governance, and improve quality assurance practices.

WHAT YOU'LL NEED

• Bachelor’s degree or 2–4 years of relevant experience in a healthcare or revenue cycle environment.
• Strong understanding of hospital revenue cycle workflows and provider reimbursement processes, gained through direct healthcare experience or work with RCM technology.
• Intermediate–advanced Excel proficiency, including the ability to build and troubleshoot complex formulas, analyze large datasets, create pivot tables, and develop data‑driven insights.
• Experience using analytical tools such as Power BI and SQL databases to investigate trends, anomalies, and root causes.
• Ability to interpret complex payer and government policies and translate them into clear, structured rule logic.
• Strong documentation skills, with experience creating rule specifications, process documentation, and testing materials.
• Quality‑focused mindset, with experience performing unit, integration, and acceptance testing to validate rule accuracy.
• Cross‑functional communication skills, with the ability to collaborate effectively across client support, product, and technology teams.
• Demonstrated ability to analyze complex problems and design creative, data‑driven solutions.
• Excellent planning and organizational skills; able to independently lead projects and manage competing priorities.
• Exceptional written communication skills, with the ability to clearly articulate complex concepts.
• Adaptability and comfort working in a fast‑moving, evolving environment.
• Medical claims coding certification (e.g., CPC) preferred.

WAYSTAR PERKS

• 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

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.