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EDI Manager

  • Location: Long Beach, CA
  • Start Date: 5/10/2024
  • Job ID: 24-00250
  • Posting Date: 5/10/2024
  • Job Type: Direct Placement
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  • Develop and Support a paperless (electronic) system for conducting business
  • Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data
  • Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical” data submissions to health plan trading partners or designated clearinghouses.
  • Responsible for full reconciliation of encounter data between clients, Health plans and CMS
  • Responsible for analysis of Care gap reports and to identify data gaps.
  • Support the centralization of information for using OnBase for content management
  • Support claims in load processes and procedures
  • Lead all Encounter and EDI related projects
  • Attend various meeting including: Operations, project specific, JOCs / encounter performance and adhoc.
  • Communicate business needs, requirements and enhancement ideas
  • Report issues and failures.
  • Confirm audit and/or exception reports are run at appropriate frequencies and identified items and exceptions are resolved satisfactorily and within expected timeframes.
  • Work with team to enhance operations, comply with new regulations, resolve failures and document policies and procedures
Required Skills and Abilities
  • Bachelor's Degree (four-year college or technical school) Required, Field of Study: Computer Science, Information Systems or equivalent experience
  • 3+ years of experience in Software Development.
  • Thorough knowledge of programming languages including VB, C#, SQL, PowerShell
  • 3+ years of SQL Server ETL Development experience using SSIS
  • 3+ years of experience with Microsoft SQL Reporting Services (SSRS)
  • Proficient in using Team Foundation Server for source control
  • Experience with SQL Server 2012
  • Experience with Transactional Systems, specifically X12 Claims, Eligibility and Authorization transactions.
  • EZCAP and EZEDI experience preferred.
  • Experience with encounter data submission preferred
  • Project management skills in the context of software development preferred
  • Previous experience in the healthcare or finance industry preferred
Posted by Andy Oliver
Technical Recruiting Director
(800) 821-4644 x 9223