is responsible for the strategic direction and technical support of Electronic Data Interchange (EDI) processes. This includes managing the department by establishing the daily monitoring of EDI file processing, the troubleshooting of issues impacting successful receipt or delivery of client files, the setup and testing of new additions to existing trading partners, and general customer support of issues.
Oversee the production support of existing EDI trading partners
Responsible for managing the technical teams, processes, and tool sets required to support EDI.
Implement process improvements to enhance the efficiency of the EDI processes.
Assess, recommend, develop, implement and maintain processes, procedures, scripts, programs, documentation, etc. required to effectively deploy solutions for the EDI environment.
Perform routine and ad hoc analysis of various facets of EDI processing including but not limited to system performance, claim turnaround times, data mapping, and claim volumes.
Monitor the production environment and proactively prioritize, communicate, and resolve any EDI process or system issues.
Communicate system and interface availability, modifications, and problems to internal and external stakeholders as needed and according to established policies and procedures.
Determine estimates for time and cost of work as well as feasibility and compatibility with other systems.
Prepare and maintain documentation that defines operational procedures, describes client requirements, and shares relevant analysis outcomes with internal and external stakeholders.
Support clients and trading partners with their non-standard requests for ad hoc reports, testing analysis and other technical deliverables.
Handling questions and issues from internal users and trading partners. This includes, but not limited to working with outside customers, terminals and customer service on pickups and working with the billing and collections groups to make sure the references numbers are being sent out on invoices.
Analyze and develop specifications for EDI enhancements
Evaluation and selection of vendor services and tools to meet long term strategic objectives.
Responsible for various information systems and the resolution of related problems. Assigns staff to various projects and directs activities. Prepares activity and progress reports. Confers with and advises staff on administrative policies and procedures, technical problems, priorities, and methods. May develop business plans and annual budgets. Accountable for budget, staff planning, management, and product and service delivery.
Responsible for staff and activities associated with the identification, prioritization, and resolution of problems. May ensure that all phases of support are coordinated, monitored, logged, tracked, and resolved appropriately. May be responsible for all activities relating to the operation of centralized data processing equipment and peripheral information systems equipment. May establish detailed schedules for the utilization and tracking of all IT equipment.
Bachelor’s Degree in Info Systems, Business or other related field or equivalent experience is required.
5 plus years Health EDI Industry experiences preferred
3-5 years of progressive leadership experience, preferably in EDI
Exposure and general understanding of Healthcare claims processing and carrier protocol as it pertains to claims filing/processing.
Preferred EDI experience with healthcare X12 transition sets.
Experienced in the design, development, implementation, and production activities associated with customer & vendor transaction sets, EDI data standards and standard communication protocols (HTTP, FTP, AS2)
In depth knowledge with EDI middleware products such as BizTalk, IBM Sterling Commerce, etc.
Minimum Requirements: Bachelors’ degree or equivalent. At least five years of experience in information technology.
HealthSpring is a EEO/AA employer.
HealthSpring - 17 months ago
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