Job Title: EDI Specialist

Job ID: 2023-11993

Job Location: Remote

Job Travel Location(s):

# Positions: 1

Employment Type: W2

Candidate Constraints:

Duration: Long Term

# of Layers: 0

Work Eligibility: All Work Authorizations are Permitted

Key Technology: SQL, SSRS, tabular/matrix reporting, SSIS, SQL Optimization, Azure DevOps, Git

Job Responsibilities:

Product, EDI & Adjudication Partnership Platforms role is a management role responsible for working closely across the product management, operations, and technology teams to ensure execution and delivery of initiatives focused on electronic data interchange (EDI) and partnerships with Adjudication Systems. Specifically, the Product Manager will be responsible for delivering cross-product technology solutions to enhance the service experience for stakeholders, including payers, providers, and members. The lead will own driving the strategy for and development of a division wide EDI standardization plan, building strategy around partner adjudication systems, Clearinghouse consolidation, building monitoring and measuring plans, and, critically, planning for how to use EDI and the existing and strategic partnerships as a strength.

Key Responsibilities

• Drive strategy for and development of a cross-product EDI solution, especially focused on adjudication system partnerships, to drive an optimal experience for payers, providers, and members
  • Inventory current EDI / Adjudication partners and assess current state gaps and needs
  • Provides subject matter expertise in areas including EDI utilization for development, workflows, use cases, user interface design, and specifications.
  • Lead and drive delivery of EDI and strategic partnerships by working with shared services teams; responsibilities include identifying and managing cross-team dependencies to align on the release schedule, proactively developing solutions, delivering platform requirements and defining acceptance criteria.
  • Manage customer needs for platform enhancements and improvements; and proactively develops solutions to meet a diverse client base
• Partner closely with operations and IT on potential platform migrations: assess business case, perform gap analysis
• Prepare and communicate program level status reporting to key constituents, stakeholders, and executive team
• Actively contribute new ideas and support ad hoc projects, including time-sensitive requests
• Accurately scopes out projects, sets objectives and goals, develops schedules, measures performance against goals, and evaluates results
• Responsible for creating and maintaining any collateral documentation such as release notes, training guides, etc.
• Responsible for creating and maintaining client and market focused collateral explaining experience and use cases for outside distribution
• Responsible for thought leadership market communication (e.g., articles, webinars, posts) to help sell our vision on why the integration of the member, provider, and payer is key to a well delivered overall solution
• Mentor staff and team members to ensure alignment with goals
• Ensure compliance with HIPAA regulations and requirements.
• Maintain awareness of and ensure adherence to standards regarding privacy

Skills and Experience Required:

• 10+ years of product management or product delivery experience
• Experience driving specifications, delivery, and design for utilizing EDI
• Experience with managing partner relationships, particularly in the adjudication space
• Experience with UI and UX
• Familiarity with Agile software development
• Background and / or understanding of the healthcare industry