Employer: DentaQuest
Job Description
The Manager, Electronic Data Interchange (EDI) is responsible for leading the daily activities and the strategic direction of the Electronic Data Interchange team of analysts in this key leadership role. The EDI team, in partnership with IT and other Operations functions, plays a pivotal role in ensuring that DentaQuest’s, trading partners’, clearing houses’, clients’ and providers’ electronic transactions are consistent with industry best practices and compliant with HIPAA and all state and federal regulations. Using your solid knowledge of EDI, you will strategize, implement, and manage successful EDI solutions that will strengthen our core and further scale our operations. You will serve as a key liaison between internal business and IT functions for all Operations electronic data interchange requirements that may include claims, eligibility, providers and/or encounters. As a key stakeholder and business leader, your commitment to continuous improvement efforts by developing new business processes and strategic leadership will help us best serve our clients, providers, and members.
PRIMARY JOB RESPONSIBILITIES:
- Responsible for the design and architecture of scalable and robust EDI solutions
- Lead the development of database application configurations and tracking mechanisms for EDI
- Ensure development, documentation, and communication of progress reports pertaining to EDI transaction maps, business edits and new trading partner onboarding
- Manage EDI related business support responsibilities, which include production monitoring, file maintenance, ad hoc reporting, and consultation with internal and external users
- Identify EDI process efficiency improvements and implement changes
- Explore opportunities to strengthen and augment our EDI capabilities and expand the utilization of clearinghouses and other trading partner service offerings
- Create and integrate maps and processes within EDI systems
- Participate in and provide analytical support for the design and implementation of new systems
- Ensure complete documentation of EDI maps and business edits and manage the execution of user acceptance testing for healthcare EDI transactions (such as ANSI X12N 835, 837, 997/999, 270/271, 276/277, and 278)
- Perform team administrative duties including status reporting, team development, self/peer/project assessments
- Develop analytical skills, increase applications knowledge within the team, lead efforts to develop department core competencies, execute cross training, carry out personnel management activities and implement succession plans
- Mentor, coach, and guide staff under EDI Management team
- Collaborate with IT management peers to facilitate the alignment of organizational business and information technology strategies and plans
- Provide ongoing internal customer support for EDI product questions and problems
- Ensure appropriate level of support for the ongoing performance of EDI processes and applications
- Maintain a leadership role in setting service direction and ensure compliant standards and policies are maintained
- Collaborate with Operations management peers to improve departmental and organizational performance by developing benchmark measures to evaluate productivity and service quality
- Serve as the organization’s EDI subject matter expert on electronic transactions
- Other responsibilities as assigned
Location(s) Remote, Work from Home,
Requirements
Required:
- Bachelor’s degree
- Extensive experience with EDI especially in a healthcare system environment
- Proficient knowledge in:
- EDI applications including the EDI Gateway, Edifecs suite of tools, Microsoft Biztalk, Microsoft SQL Server, and other applications in support of EDI processing
- HIPAA/EDI X12 5010 healthcare-related transactions such as 270-271, 276-277, 277CA, 277U, 278, 820, 834, 835, 837, 999, and 824
- HIPAA security policies and procedures
- Fluent with commonly used EDI concepts, practices, and procedures within a heath care field
- Knowledge of industry standard health data code sets, most specifically CDT and ICD-9/ICD-10
- Specific knowledge of claims, enrollment, and /or authorizations in a Medicaid or Medicare environment
- Systems implementation
- Experience working with business stakeholders to define application strategies, roadmaps, and funding requests
- Strategic EDI thinking and planning with operational execution excellence
- Strong interpersonal and verbal/written communication skills
Preferred:
- Experience with U.S. healthcare & insurance industry is highly desirable
- Ability to build and foster strong interpersonal relationships in a remote setting
