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:
- 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.
- 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