EDI Lead / Lead EDI Analyst with extensive Healthcare experience

The EDI Lead manages and responsible for the overall EDI/Interoperability process. The position is responsible for managing, planning, and guiding the daily EDI operations and ensuring the plan s Trading Partners, contracted networks, hospitals, government agencies and providers transactions (X12, HL7, NCPDP, Proprietary, FHIR) are in compliance with HIPAA, CMS, DHCS and DMHC mandates, regulations and policies. This position also includes the role of liaison between all the internal Business Units for all EDI/Interoperability requirements, particularly eligibility, provider data, claims, clinical data and encounters. In addition, develop and provide oversight of EDI/Interoperability processes and documentation. The lead is responsible for all EDI/Interoperability related projects. The Lead manages all EDI/Interoperability priorities and assignments working with the IT Applications Managers and Director.

• Manage relationships between trading partners and client
• Liaison between business units and the EDI/Interoperability team
• Ensure the client is compliant with mandates for all data exchanges
• Develop and oversee the EDI/Interoperability release processes working with the IT Delivery team.
• Oversee work intake, prioritization, assignment and maintenance of EDI/Interoperability processes and applications
• Ensure adherence to the IT Change Management process
• Contribute to the design and architecture of scalable and robust EDI solutions
• Serve as the subject matter expert the development, deployment and maintenance of transaction maps, edits and formats for all data exchanges
• Participate in and provide analytical support for the design and implementation of new systems
• Oversee operational support for EDI platform and applications, including issue resolution
• Participate in the development, documentation, communication and maintenance of transparency and reconciliation for all transactions.
• Manage EDI-related business support responsibilities, which include production monitoring, file maintenance, ad hoc reporting, and consultation with internal and external users
• Perform team administrative duties including status reporting
• Ensure an appropriate level of support for the ongoing performance of operational processes and applications.
• Collaborate with all IT Management peers to improve departmental and organizational performance by developing benchmark measures to evaluate productivity and service quality.
• Utilize strong communication and management skills to strengthen partnerships
• Keep informed on existing and evolving industry standards, practices, and technologies.
• Focus on quality and attentive to detail and accuracy and plan for improvements for any quality deficiencies found in EDI processes.
• Perform other duties as assigned.

Understand and support the client mission and its overarching business goals and objectives.

Act with integrity, honesty and fairness, remaining mindful of the duty of trust Client has to it employees, and to its providers, employers and members.

Accepting and adapt to changes in Client policy, practice, procedures quickly and positively and proactively supports his/her direct reports and colleagues in adapting to changes in the workplace.

Contribute actively and effectively to management team discussions, sharing his/her knowledge and expertise willingly and collaboratively.

Identify business process improvements that are aligned with and supportive of Client business goals and objectives. Provides thoughtful analyses and recommendations.

Model professional behavior/conduct that remains in concert with the client culture and business values.

• In-depth knowledge of HIPAA/EDI X12 5010 healthcare-related file formats X12 and FHIR HL7 formats.
• Ability to synthesize data from various sources and perform various types of data analysis.
• Ability to produce accurate and precise work, detect discrepancies and resolve discrepancies all while meeting deadlines.
• Ability to work effectively, independently, and as part of a team.

Strong oral, verbal and written communication skills.

Advanced analytical skills and problem-solving skills with the ability to formulate and communicate recommendations for improvement.

• Knowledge and application of English grammar including composition, editing, and proofreading skills. Demonstrated ability to coordinate cross-functional work teams toward task completion.
• Demonstrated effective leadership and analytical skills.
• General PC knowledge including Microsoft Office.

• Bachelor s degree or higher or relevant industry experience
• Proven experience as an EDI analyst, with a minimum of 5 to 7 years
• Knowledge of Qnxt and/or other Cognizant solutions.
• Minimum 5-7 years of experience using Edifecs products preferred
• PC literacy and demonstrated experience with MS Office (Outlook, Word, Excel, PowerPoint).
• Excellent human relations and verbal/written communication skills
• Creative and analytical problem-solving skills
• Ability to make sound independent decisions
• Strong interpersonal skills

Experience with health care organization or health plan preferred.

Experience in the implementation of new systems is preferred.

• Familiar with health care, managed care terminology, or Medi-Cal preferred.