Manager, EDI
ASH Companies - San Diego, CA

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The function of this position is to manage, direct and support a team of programmers and analysts to design, develop and implement translators and mappers to ensure compliance with HIPAA transaction set processing; design solutions to problems; direct and develop testing procedures for HIPAA transaction set processing; perform gap analyses and suggest resolution; direct and support and perform systems analysis and design solutions for timely loading of Health Plan eligibility, benefit and group information and streamlining reporting processes; manage and direct the timely Trading Partner submission of claims and claim encounter data. Also responsible for managing reporting functions, including performance standards, provider reporting, GEOACCESS, and accurate capitation exception reports. Responsible for standardizing and streamlining reporting processes, and developing a solid reporting architecture that will support current and future needs.
· Implement and manage EDI projects.
· Manage and design the development of EDI tools to facilitate electronic exchange of transactional data between HP Trading Partners by creating standard formats for transmitting electronic HIPAA compliant transactions such as claims/encounters and enrollment.
· Promote efficient and effective HIPAA compliance approaches and solutions.
· Identify/document plans and implementation planning; create/update plans related to EDI implementation.
· Promote efficient and effective HIPAA compliance approaches and solutions.
· Design the implementation of EDI data transfers into organization’s operational systems.
· Manage the development of EDI solutions to help reduce manual data entry.
· Manage accurate standardized EDI, performance and provider reports for use by end-users.
· Identify opportunities to specifically increase business efficiency through EDI.
· Serve as an EDI/HIPAA expert for the organization.
· Redesign manage internal clearinghouse.
· Work with implementation team to obtain electronic files from health plans and clients.
· Work with client’s software development representatives to test and implement EDI transactions.
· Insure the quality and accuracy of inbound and outbound data.
· Attend scheduled operations, development, and other meetings to discuss issues and foster teamwork among department and operations personnel.
Education/Training/Experience/Licenses
·
Bachelor’s degree or equivalent.
· 5 years of progressive experience performing computer programming using Visual Basic and SQL in a network environment.
· Solid, hands-on experience with multiple reporting tools.
· Process oriented focused on standardization, streamlining, and implementation of best practices.
· Experience with healthcare standard formats, NSF,ANSI, HIPAA, etc.
Knowledge/Skills/Abilities:
·
Strong verbal and written communication skills.
· Ability to translate business requirements to technical specifications.
· Knowledge of business operations, database structures, transactional data processing and reporting solutions to meet business needs.
· Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
· Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
· Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
· Demonstrated accuracy and productivity in a changing environment with constant interruptions.
· Ability to exercise strict confidentiality in all matters.
Mobility: Primarily sedentary, able to sit for long periods of time.

Physical Requirements: Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions: Usual office setting.

ASH Companies - 18 months ago - save job - block
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