The EDI Manager is responsible for managing the daily electronic data interchange (EDI) operations, including planning, implementation, and maintenance. Departmental responsibilities include: developing and implementing strategies for EDI capabilities, investigating and developing new EDI solutions for business operations, overseeing and coordinating the implementation of new EDI systems, enhancements and upgrades.
Develops and implements an EDI strategy to support organizational initiatives to support transformation with the opportunities under healthcare reform.
Manages and leads the EDI initiatives including documentation, quality assurance, implementation support, and workflow management.
Represents First Choice Health at industry, OneHealthPort and WA Exchange meetings related to EDI transactions.
Performs thorough analysis of all X12 transactions to ensure that the organization is taking advantage of the efficiencies to be gained from it.
Oversees EDI Business Analysts that are responsible for design and development of EDI application interfaces.
Manages the key vendor relationships including the software provider for clearing houses.
Manages all incoming EDI; both claims and eligibility. Works with client and/or clearinghouse to ensure success and data integrity.
Provides project management skills to support effective and efficient resolution to technical issues and concerns.
Provides training to end users.
Analyzes technical/operational issues identified by end users. Thoroughly documents specifications to resolve technical issue to meet business objectives.
Develops, tests and implements system changes/enhancements that help the business remain effective and efficient.
Provides oversight and project managment for implementation of EDI components for all new product launches and associated software to support it.
Works with IT System and Business Analysts to manage all systems analytical work.
Supports inter-departmental teams to optimize integration with other system environments.
Supports reporting staff to ensure coordination and integration of all system modifications.
Provides analytical support for all information systems.
Thoroughly documents Business specifications to resolve technical issues to meet business objectives.
Works closely with Information Systems to bridge communication gaps between business units and programming team.
Provides assists in documenting workflow enhancements as it relates to integration with information systems.
Other projects as directed.
Bachelors degree in Information Technology related field.
Eight (8) years health care work experience in the insurance industry, preferably in a managed care environment.
Well versed in X12 HIPAA-Mandated transactions.
Experience working with Information Systems staff and user staff.
Experience in using reporting systems, relational databases, and querying languages including MS Excel, InfoMaker, MS Access, and SQL.
Understanding of provider contracts, reimbursement methodologies and pricing issues as they apply in a managed care environment.
Strong knowledge of medical coding - ICD9, CPT, HCPCS, etc.
Strong written, verbal, and interpersonal skills.
Strong demonstrated analytical abilities, with attention to details.
Ability to organize, manage, control work flow, and meet deadlines.
Ability to manage and lead teams.
Please submit your resume to email@example.com .
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