Offer summary

Qualifications:

Strong knowledge of EDI protocols, Solid understanding of healthcare workflows, Proficiency with Salesforce and JIRA, 3 years experience in healthcare eligibility.

Key responsabilities:

Manage electronic exchange of healthcare information

Monitoring and troubleshooting EDI transactions

Job description

Position EDI Projesct Manager with HIPPA

Location: Remote
Duration: 6 Months+

Required Skills
- EDI experience - Healthcare experience - Payer connectivity - X12 transactions

Job Description
The EDI PM will manage and support the electronic exchange of healthcare information. Responsibilities include establishing connectivity to exchange transactions, monitoring and troubleshooting EDI transactions, ensuring compliance with HIPAA regulations, and collaborating with internal teams and external partners. The role involves optimizing product solutions, supporting process improvements, and navigating automation and AI technologies. The EDI PM will also manage payer-specific edits and leverage internal relationships to resolve transaction issues, all while handling multiple tasks in a fast-paced environment.

Monitor and troubleshoot EDI transactions to resolve errors promptly.
Collaborate with internal teams and external partners on EDI issues.
Ensure EDI transactions comply with HIPAA regulations.
Communicate EDI connectivity issues with stakeholders.
Identify process improvement opportunities with IT, operations, and business teams.
Strong knowledge of transaction sets (270/271, 276/277, 278, 837, 835) and Patient Estimates.
Optimize product solutions by managing payer-specific edits.
Handle multiple tasks in a fast-paced environment.
Support automation and AI technologies.
Leverage internal relationships to resolve transaction issues.
Work all Salesforce Case and Jira(s) timely, Document issues in Salesforce, Jira or any other established tools
Communicate with internal and external stakeholders regarding EDI, API, and web/screen capture connectivity issues.
Develop and maintain EDI documentation, including companion guides, smart checklists, payer lists, and internal process documentation.
Host external working sessions with trading partners, vendors, and clients as needed.
Maintain and grow direct connections with product and technology teams.
Provide training and support to internal teams on EDI processes and best practices.
Other duties as required

Qualifications

Strong knowledge of EDI protocols and standards (27x and 83x healthcare transactions).
Solid understanding of healthcare reimbursement and patient access workflows.
Excellent analytical and problem-solving skills for complex EDI issues.
Proficiency with Salesforce, Atlassian JIRA, Microsoft 365, Excel.
Strong organizational skills for project completion and documentation.
Adaptable to changing environments and workloads.
Excellent verbal and written communication skills.
High attention to detail and accuracy in EDI transactions and documentation.
Familiarity with agile methodologies (Scrum, Kanban).
Knowledge of EDI communication protocols (AS2, SFTP, API).
Experience with EDI integration in healthcare management systems (e.g., Epic, Cerner).
Demonstrated SQL query skills/experience preferred.
EcareNext/PE familiarity preferred.

Special Skills

3 years solid Healthcare eligibility benefits and reimbursement experience (hospital and physician) required
Understanding of X12 270/271 message/file formats and transactions required
Effective communication and relationship building skills
Demonstrated skill gathering, analyzing, inputting and manipulating healthcare data
Demonstrated skill using Excel for analysis
Self-motivated, autonomous, driven to achieve excellence
Demonstrated SQL query skills / experience preferred
EcareNext/PE familiarity preferred