Manager EDI (Finance)

Job Summary

The Manager EDI Operations EOB and Auditing reports directly to the Director of Claims and Performance Auditing. Responsibilities include managing all Claims EDI operations, ensuring alignment with organizational goals, developing strategic plans for EDI Operations, including stakeholder coordination and process improvements and to serve as the primary point of contact for executive leadership.

Key Skills: Leadership, strategic planning, vendor management, understanding of EDI protocols and healthcare industry standards.

Experience: Eight to ten years of progressively responsible related X12 EDI experience. Experience    managing, coaching, and mentoring technical/operations professionals at various levels.

Responsibilities

Accountable for providing capable X12 business/technical resources and expertise to enable delivery of EDI services.

•           Provides quality expertise and input, when needed, during EDI project planning, scoping and prioritization of processing

•           Sets strategy and direction for technical/operational competency. 

•           Supports Operations by providing expertise and skills for EDI maintenance activities, when needed.

•       Collaborates with Operations leaders as part of work demand management to maximize staff utilization and effectiveness. Balances supply and demand for resources to support EDI business/systems requirements 

•       Collaborates with stakeholders on fulfilling resource needs (type, level, timing) balancing work requirements while maximizing resource utilization.

•       Assures that resources assigned to work assignments are capable of meeting assignment expectations.

•        Accountable for staff utilization and effectiveness.

•        Responds to changes to work schedules and resource requirements (timing, requirements, scope). Quickly adapts to changes and adjusts forecasts and resource assignments.

•       Establishes performance tracking requirements and drives frameworks and processes to monitor EDI technical competency performance versus expected levels. Performs regular communications with stakeholders on performance and issues.

•       Sets Technical Competency objectives by defining the team's roles and responsibilities

•        Accountable for maintaining and continually upgrading technical competency best practices, tools, techniques, reusable assets and processes. Ensure that required processes and tools are in place and executing optimally to achieve objectives.

•        Accountable for establishing and maintaining communications with external and internal sources to monitor trends for upgrading competency.

•       Supports Operations Leadership on identifying and securing of strategic vendor services and relationships. Accountable for managing ongoing vendor relationships working with cross-functional teams.

•       Accountable for implementing and maintaining a supplemental staffing model and plan.

•       Responsible for competency continuous improvement and enforces the concept of total quality management throughout the staff.

•        Accountable for creation, maintenance, upgrade and availability of core competency including, techniques, best practices, etc.

•       Accountable for competency career progression, coaching, mentoring, and training.

•           Administrative Manager for all competency staff. Maintains regular contact with assigned resources and BTS t to mitigate issues.