Manager of Healthcare EDI

Job Summary:  

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.

Duties and 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. 

Required Knowledge, Skills, and Abilities:

• Bachelor’s Degree in computer science, mathematics or informatics or equivalent experience
• 4+ years of informatics, reporting, EDI technology in a supervisory role;  in healthcare, insurance or third-party benefits administration 
• 4+ years’ experience with EDI formats related to healthcare including 837, 835, 999 and 834s.
• Knowledge of health data security and related regulatory requirements and EDI document formats.
• Experience with Microsoft SQL Server and PostGREsql databases.
• Experience writing SQL or PostgreSQL queries.
• Experience with reporting dashboard tools such as Actuate, Tableau and PowerBI.
• Eldorado Javelina claims management platform experience a plus.
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint
• Ability using a computer which includes expert keyboard and navigation skills and learning new programs
• 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. 
• Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment 
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively
• Teach, coach, and counsel associates by effectively communicating and providing follow-up.
• Open to other’s ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and can deal with frequent changes, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers.  
• Work overtime as required

Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally      move about the office
• Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus
• Occasional: Lift and/or move up to 10 pounds
• Constant: Regular, predictable attendance in the office is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
• Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing,      categorizing, and integrating information for decision making, problem-solving, and comprehending. 

Work Environment: The work environment described is representative of what must be met by an employee successfully to perform the essential functions of this job.  

• The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.