Manager EDI
Job Summary
The Manager EDI Operations reports directly to the Director of Claims and Performance Auditing. Responsibilities include managing all Claims EDI operations, ensuring alignment with organizational goals, developing strategic plans for EDI Operations, including stakeholder coordination and process improvements and to serve as the primary point of contact for executive leadership. This role is a technical leadership position that requires extensive experience in the mapping and translation for various platforms including X12 formats, 835 balancing, HIPPA Compliance edits, and Blue Exchange Licensee Requirements (BCBSA). This role will support external entities including facilitated networks, internal customers and other key vendors.
Key Skills: Leadership, strategic planning, vendor management, understanding of EDI protocols and healthcare industry standards.
Experience: Eight to ten years of progressively responsible related X12 EDI experience. Experience managing, coaching, and mentoring technical/operations professionals at various levels.
Responsibilities
Accountable for providing capable X12 business/technical resources and expertise to enable delivery of EDI services.
- Provides business analysis, application architecture, design, development, integration and delivery by providing business knowledge of corporate operations, to project teams. .
- Participates in mapping the technical application architecture to the chosen technology platform. Defines application components, platforms, interfaces, and development tools.
- Provides technical guidance to application development teams. Consults on integration and conversion activities. Develop and design system requirement for business information systems. Selects technologies to provide long-term compatibility and flexibility.
- Provides technical direction to business project leaders in all aspects of technical design and development to ensure that goals and objectives for assigned projects are accomplished in accordance with prescribed business priorities.
- Manages and oversees the system development process, including development of strategic plans and projects of high business complexity.
- Develops detailed plans and schedules application programming projects including goals, risks, resource allocation, and project estimates. Monitors project results for significant deviations.
- Manages Provider and Internal Customer relations to ensure that service expectations are developed and met.
- Establishes and maintains alliances with key partners, championing product concepts and strategies.
- Provides expertise on technical transactions defined by product line(s). Advises on product implementation strategies, modifications and extensions to existing products.
- Builds and maintains the infrastructure for configuration and release management for all development. Coordinates product release efforts including system mapping, documentation and training.
- Oversee configuration management procedures and processes as well as configures and administer version control and issue tracking.
- Optimizes phased-release approach to product development and testing; implements tools for configuration management, defect tracking and change control.
- Demonstrates experience in the mapping and translation for various platforms including X12 formats, 835 balancing, HIPPA Compliance edits, and Blue Exchange Licensee Requirements (BCBSA).
- Support vendor management (PNC/ECHO, 270/271 – Teladoc)
- Assist in Master Test Strategy; provide testing scenarios/results – develop testbeds for regression
- Provides quality expertise and input, when needed, during EDI project planning, scoping and prioritization of processing
· Sets strategy and direction for technical/operational competency.
- Supports Operations by providing expertise and skills for EDI maintenance activities, when needed.
· Sets Technical Competency objectives by defining the team's roles and responsibilities
· Responsible for competency continuous improvement and enforces the concept of total quality management throughout the staff.
· Accountable for creation, maintenance, upgrade and availability of core competency including, techniques, best practices, etc.
Inclusion and Belonging
At AmeriHealth, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At AmeriHealth, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
AmeriHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.