ABOUT YOU
You will be responsible for leading the daily activities and the strategic direction of the EDI team of Analysts and Programmers in this key leadership role. The team plays a pivotal role in helping our business departments, Trading Partners, contracted networks, hospitals and providers’ ASC X12 transactions be compliant with HIPAA and state/federal regulations. Using your solid knowledge of EDI, you’ll help implement and manage successful EDI solutions that will strengthen our core and further scale our operations.
You’ll be a key liaison between internal business units for all EDI / File Gateway requirements, particularly eligibility, providers, claims and encounters. And as a key stakeholder and business leader, your commitment to continuous improvement efforts by developing business processes and strategic leadership, will help us best serve our providers and members.
WHAT YOU’LL DO:
- Day to day team leadership and EDI resource development
- Liaison between key internal and external stakeholders and the EDI team
- Manage prioritization, assignment and maintenance of EDI processes and applications
- Responsible for the design and architecture of scalable and robust EDI solutions
- Create and integrate maps and processes within EDI systems
- Participate in and provide analytical support for the design and implementation of new systems
- Serve as subject matter expert for implementation and integration of EDI transaction maps.
- Develop global processes related to EDI services and support
- Oversee operational support for EDI platform and applications, including issue resolution
- Provide ongoing internal customer support for EDI product questions and problems
- Ensure development, documentation, and communication of progress reports pertaining to new EDI transaction maps, business edits and new trading partner onboarding
- Manage EDI-related business support responsibilities, which include production monitoring, file maintenance, ad hoc reporting, and consultation with internal and external users
- Perform team administrative duties including status reporting, team development, self/peer/project assessments
- Develop analytical skills and increases applications knowledge within the team and lead efforts to develop department core competencies, execute cross training, and implement succession plan.
- Carry out personnel management activities including performance management and career development.
- Mentor, coach, and guide staff under EDI Management team.
- Ensure appropriate level of support for the ongoing performance of EDI processes and applications.
- Maintain a leadership role in setting service direction and ensures standards and policies are maintained and compatible with SFHP standards
- Collaborate with all ITS Management peers to improve departmental and organizational performance by developing benchmark measures to evaluate productivity and service quality.
WHAT YOU WILL BRING
Proficient knowledge in:
- BizTalk
- EDI application mapping techniques
- Edifecs or ClarEDI
- HIPAA ASC X12 transaction sets for healthcare (834, 837, 277, 835, 997/9, 270/1, 276/7, Proprietary Auths)
- HIPAA 5010
- HIPAA security policies and procedures.
- Systems implementation
- QNXT (desirable)
Proven skills in:
- Leadership and project management, including managing/developing staff, promoting teamwork and encouraging innovative ideas.
- Working with business stakeholders to define application strategies, roadmaps and funding requests.
- Strategic thinking and planning with operational execution excellence.
Experience
- BS or equivalent combination of education and work experience
- 8 + years of IT and business work experience with a broad range of exposure to various technical environments and business units, particularly claims.
- 5+ years of progressive experience with EDI, familiarity with .net and SQL
- 3+ years of managerial experience in EDI strategic planning and daily operations.
- 5+ years of proven experience in SDLC (Waterfall, Agile) creation, implementation and enforcement.
LOCAL CANDIDATES ONLY PLEASE
US CITIZENS AND GREEN CARD HOLDERS ONLY PLEASE