Description
GJ39780
CA-Pasadena
EDI Manager Overall Function Summary
Plans, coordinates, implements, maintains and manages plans and operations for all functional aspects of HIPAA (Health Insurance Portability & Accountability Act) Administrative Simplification and related business rules which includes uniform national standards for electronic health administration transactions, code sets, identifiers, and privacy requirements. Develops and maintains mappings/cross-walks from proprietary electronic formats to the national electronic standard format. Negotiates and maintains trading partner agreements and service level agreements with all internal and external customers. Leads and coordinates testing activities, educates users and technical staff on appropriate use of maps. Develops and maintains metrics, participates in external working sessions. Leads and coordinates problem solving efforts and makes recommendations for their resolution or solves as appropriate. Drafts multi-year EDI cross functional regional and application plans.
Responsibilities
Manages the efforts of direct reporting, as well as Matrix reporting, positions. Responsible for selecting, developing, and deploying personnel in the most effective manner to meet assigned objectives. Responsible for performance management, and providing on-going, regular developmental feedback.
Facilitates communications, manages relationships with stakeholders, and garners support and agreement from involved parties for compliance initiatives and programs in assigned functional areas.
Issue Management, Response, and Mitigation: Responsible for issue management, response, and mitigation in assigned functional areas. Anticipates issues through regular communication with reporting positions, mitigating risk or escalating issues for resolution by more senior levels as necessary.
Change Management: Responsible for leading change management efforts related both to specific functional areas as well as larger departmental goals or objectives. Identifies and acts upon opportunities to leverage direct reporting team in change management activities; ensures direct reporting team is engaged in change management as appropriate.
Project Management: Responsible for management of project plans for individual objectives or projects as well as ensuring project timelines and objectives are met for projects managed by reporting positions.
Strategic development: Provides information relative to the identification and development of objectives, goals, and strategy relative to individual functional area. May participate in development of same.
Requirements
2-3 years of management experience and 8-10 years of Claims/Membership EDI transaction processing related experience
Good knowledge of EDI policies, practices, regulatory compliance and systems.
Good knowledge of EDI standards.
Project management skills
Staff management/leadership skills
Requires strong ability to influence and negotiate tasks, resources, and outcomes of others outside their direct supervisory control.
Knowledge of EDI practices in the health care field
Knowledge of National EDI Standards Organizations as HL7, ASC X12, WEDI, EHNAC etc.
Knowledge of medical claim and related transaction processes and procedures
Bachelor's degree, Masters preferred in Health Care or related business field.
National EDI standards training as may be indicated by the obtaining of the Certified HIPAA Professional or similar certificate