Manager EDI
Job Summary
The Manager EDI Operations EOB and Auditing 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.
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 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.
• Collaborates with Operations leaders as part of work demand management to maximize staff utilization and effectiveness. Balances supply and demand for resources to support EDI business/systems requirements
• Collaborates with stakeholders on fulfilling resource needs (type, level, timing) balancing work requirements while maximizing resource utilization.
• Assures that resources assigned to work assignments are capable of meeting assignment expectations.
• Accountable for staff utilization and effectiveness.
• Responds to changes to work schedules and resource requirements (timing, requirements, scope). Quickly adapts to changes and adjusts forecasts and resource assignments.
• Establishes performance tracking requirements and drives frameworks and processes to monitor EDI technical competency performance versus expected levels. Performs regular communications with stakeholders on performance and issues.
• Sets Technical Competency objectives by defining the team's roles and responsibilities
• Accountable for maintaining and continually upgrading technical competency best practices, tools, techniques, reusable assets and processes. Ensure that required processes and tools are in place and executing optimally to achieve objectives.
• Accountable for establishing and maintaining communications with external and internal sources to monitor trends for upgrading competency.
• Supports Operations Leadership on identifying and securing of strategic vendor services and relationships. Accountable for managing ongoing vendor relationships working with cross-functional teams.
• Accountable for implementing and maintaining a supplemental staffing model and plan.
• 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.
• Accountable for competency career progression, coaching, mentoring, and training.
• Administrative Manager for all competency staff. Maintains regular contact with assigned resources and BTS t to mitigate issues.
Inclusion and Belonging
At IBX, 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 Independence, 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
IBX 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 Independence Blue Cross 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 Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.