Position Summary
The EDI Manager will be responsible for overseeing and managing the EDI operations and initiatives for a third-party administrator specializing in health care benefits. This role ensures the seamless exchange of electronic transactions between the organization and its partners, including health care providers, insurance companies, and other stakeholders. The EDI Manager will lead a team, manage EDI projects, and work collaboratively with various departments to optimize EDI processes and compliance with industry standards.
Essential Duties and Responsibilities
· Oversee daily EDI operations, ensuring timely and accurate data exchange.
Monitor EDI transactions and troubleshoot issues as they arise.
Ensure compliance with industry standards (HIPAA, X12, etc.) and company policies. Day-to-day team leadership and EDI resource development.
Liaison between business units and the EDI team.
Manage work intake, prioritization, assignment and maintenance of EDI processes and applications.
Ensure adherence to the ITS Change Management process.
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.
Oversee operational support for EDI platform and applications, including monitoring and 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, and self/peer/project assessments.
Ensure appropriate level of support for the ongoing performance of EDI processes and applications.
Other responsibilities as assigned.
Qualifications
Bachelor's degree in MIS or similar field
5+ years of EDI management experience and similar working in EDI Development
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.
Expertise with HIPAA 5010 ASC X12 transaction sets for healthcare (834, 837, 277, 835, 997/9, 270/1, 276/7, 278) as well as proprietary formats.
Knowledge of HIPAA policies and procedures.
Familiar with programming languages (C#, SQL) and methodologies (SDLC)
Experience with Qiclink, VBA and Healthpac preferred.
