Job Description
* Candidates must reside in: AZ, CT, FL, GA, IL, IN, KS, KY, MI, NJ, NY, OH, OK, SC, TN, or TX*
The Manager of Healthcare EDI will have responsibility for supervising and coordinating the EDI team. This role will lead the team responsible for successful daily EDI file transmissions and internal reporting processes, as well as participating in projects and technical implementations with vendors and clients. This role will optimize EDI operations to enhance efficiency, accuracy and collaborate across the organization as well as with clients and vendors.
Responsibilities: - Oversee the team responsible for developing and executing technical solutions to optimize EDI operations.
- Oversee a team of EDI experts tasked with designing, documenting, and maintaining technical solutions for inbound and outbound data needs.
- Facilitate communication and collaboration between business users and developers to translate business needs into requirements.
- Manage reporting and EDI workflow planning and resources across the organization.
- Lead the EDI/reporting component of new client and vendor implementation projects.
- Liaise with other departments to resolve reporting, data, and EDI issues.
- Collaborate with the Project Management Team to develop scope of work and timeline and milestones for new projects.
- Identify and develop reasonable timelines and milestones for changes, defect corrections, improvements, or enhancements to existing data flows.
- Oversee generation, transmission, and maintenance of both inbound and outbound EDI data.
- Identify opportunities to improve relevant processes for service delivery, operational efficiencies, and effectiveness.
- Provide training and support to end-users on workflows and system enhancements.
- Audit, QA and UAT programming and configuration outputs, break fixes, enhancements, improvements, and changes.
- Develop and maintain reasonable dashboards which support the team and the organization.
- Develop and maintain documentation related to configuration, workflow, and process execution.
- Develop and maintain appropriate internal audit of the EDI processes and performance.
- Develop and maintain appropriate performance measures of the EDI team, processes, and performance.
Experience: - 10+ years of experience
- Experience in EDI technology, informatics, and reporting in a supervisory role in healthcare, insurance, or third-party benefits administration
- Experience with EDI formats related to healthcare including 270, 271, 278, 276, 277, 837, 835, 834, and 999.
- Knowledge of health data security and related regulatory requirements and EDI document formats.
- Knowledge of EDI claims management platforms
- Experience with Microsoft SQL Server or PostGREsql databases including writing queries
- Communicate clearly and professionally with internal and external customers
- Work effectively individually and as part of a team to achieve established outcomes.
- Understand other's roles and empower one another to take responsibility to be successful.
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