Overview
Remote
$60 - $65
Contract - W2
Contract - 12 Month(s)
Unable to Provide Sponsorship
Skills
ASC X12
Collaboration
Electronic Data Interchange
HIPAA
HITECH
HL7
Health Care
High Availability
Interfaces
Leadership
Management
Microsoft Exchange
Payments
Real-time
Regulatory Compliance
Trading
Job Details
Title: EDI Operations IT Manager
Work Authorization: OR
Location: Remote
Direct Client
< style="font-weight: 400;">Note: No C2C</>About The Role
Responsible for overseeing the design, implementation, and maintenance of EDI systems and processes that support core healthcare payer functions. Ensures the secure, accurate, and timely exchange of healthcare data between internal systems and external trading partners, including providers, clearinghouses, and government agencies. Lead a team of EDI analysts and engineers, drive compliance with HIPAA and CMS regulations, and support enterprise initiatives such as interoperability, automation, and digital transformation.
Required Experience:
- Bachelor s degree in Information Systems, Computer Science, Healthcare Administration, or related field (Master s preferred).
- 10- 15 years of IT experience
- 5+ years of experience in healthcare EDI operations, with at least 2-3 years in a leadership role.
- Ensure full compliance with HIPAA, HITECH, CMS, and other regulatory requirements.
- Manage the lifecycle of EDI transactions such as 837 Claims Submission, 835 Remittance Advice, 834 Benefit Enrollment and Maintenance, 820 Payments, 270/271 Eligibility Inquiry/Response, 276/277 Claim Status Inquiry/Response, 278 Referral/Authorization
- Ensure high availability and performance of EDI systems and interfaces.
- Develop and execute the EDI strategy aligned with enterprise IT and business goals.
- Serve as the subject matter expert on EDI standards (X12, HL7, FHIR) and payer-specific transactions.
- Collaborate with senior leadership to support initiatives such as value-based care, claims modernization, and real-time eligibility verification
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