Calibrated Healthcare - EDI Manager

This Candidate will be responsible for leading the daily activities and the strategic direction of the EDI team of Analysts and Programmer Analysts in this key leadership role.

Position Purpose

This position plays a pivotal role in helping the business departments, Trading Partners, contracted networks, hospitals and providers transactions be compliant with HIPAA and state/federal regulations. Using solid knowledge of EDI will help implement and manage successful EDI solutions that will strengthen the core and further scale operations.

The Manager will be a key liaison between internal business units for all EDI/File Gateway requirements, particularly eligibility, providers, claims and encounters. And as a key stakeholder and business leader, commitment to continuous improvement efforts by developing business processes and strategic leadership, will help to best serve the providers and members.

Duties and Responsibilities

Operations

- Liaison between management and the EDI team. Manage work intake, prioritization, assignment and maintenance of EDI processes and applications.

- Implement solutions independently or collaboratively.

- Report progress and measurements of success to Management.

- Perform routine analysis of various facets of EDI processing including but not limited to system performance, turn-around times, data mapping, etc.

- Responsible for the design and architecture of scalable and robust EDI solutions.

- Create and integrate maps and processes within EDI systems.

- Participate in and provide analytical support for the design and implementation of new systems.

- Serve as subject matter expert for implementation and integration of EDI transaction maps.

- Oversee operational support for EDI platform and applications, including issue resolution.

- Provide ongoing internal customer support for EDI product questions and problems.

- Ensure development, documentation, and communication of progress reports pertaining to new EDI transaction maps and business edits

- Manage EDI-related business support responsibilities, which include production monitoring, file maintenance, ad hoc reporting, and consultation with internal and external users.

- Ensure appropriate level of support for the ongoing performance of EDI processes and applications.

- Maintain a leadership role in setting service direction and ensures standards and policies are maintained and compatible with Client standards.

- Break / fix support of all EDI transactions into and out of our enterprise applications with a goal to reduce repetitive failures and the overall number of failures.

- Participate in projects and enhancements that require EDI functionality. Duties will include work in all phases of the SDLC:

- Other responsibilities as assigned.

- Proficient Knowledge In:

Leadership & Development

- Develop analytical skills and increases applications knowledge within the team and lead efforts to develop department core competencies, execute cross training, and implement succession plan.

- Mentor, coach, and guide staff under EDI Management team

- Leadership and project management, including managing/developing staff, promoting teamwork and encouraging innovative ideas.

Customer Focus

- Develops & maintains close customer ties, articulates customer needs, keeps priorities in focus with the desires and expectations of the customer

- Contribute to developing strategies which have substantial impact on the success of claims handling & enhance the customer experience.

- Collaboration and partnership with other leadership to create and maintain a positive and integrated customer experience from initial claims intake through ongoing adjudication and resolution.

- Directs and evaluates departmental performance and takes appropriate action to meet and/or exceed performance standards.

- Monitors & assesses trends in claims, identifies opportunities, and implements industry leading best practices & strategies to enhance the customer experience & improve claim management effectiveness.

Organizational Effectiveness

- Collaborates with internal & external stakeholders to establish credibility, trust and ensure effective service delivery of EDI organization.

- Builds organizational capability

- Maintains knowledge on current and emerging developments/trends, assesses the impact, and collaborates with senior management to incorporate new trends and developments in current and future strategies.

- Directs and enhances organizational initiatives by positively influencing and supporting change management and/or departmental/enterprise initiatives.

Proficient Skills In:

- EDI application mapping techniques.

- HIPAA security policies and procedures.

- Familiar with programming languages such as .NET & SQL.

- Systems implementation

- OCR

- CMS 1500

- UB04

- Dental knowledge preferred

- Knowledge of various EDI formats, 837 (5010AA)/834/835

Personal Attributes:

- Strong cultural competency and sensitivity.

- High level of honesty, respect, dependability and flexibility.

- Excellent interpersonal and verbal/written communication skills.

- Managing time and stress in a fast-paced and rapidly growing environment.

- Strong business acumen.

Education and Experience

- Bachelor's/Master's degree from a reputed institution

- 8+ years of experience in EDI that directly aligns with the specific responsibilities for this position

- 3+ years of managerial, supervisory experience including influencing senior management/critical stakeholders experience