Virginia Premier Health Plan, Inc.

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Manager, Electronic Data Interchange (EDI)

Manager, Electronic Data Interchange (EDI)

Job Locations 
US-VA-Richmond
Job ID 
2017-4288

Job Description

Overview

The Electronic Data Interchange (EDI) Manager is accountable for providing managerial oversight, leadership, and subject matter expertise to the Electronic Data Interchange Team. This position will be responsible for planning and developing enhancements to Virginia Premiers EDI Environment. Including, but not limited to: new business integration, process improvement, maintaining proper controls and fostering a positive working relationship with VA Premier Operational areas.

Responsibilities

Managerial Functions:

  • Hire, train and develop staff effectively. Take corrective action as necessary on a timely basis and in accordance with company policy
  • Build and maintain positive working relationships with internal and external customers to include Trading Partners, Providers, Hospitals and Billing Companies and key operational areas of the business
  • Manage staff; standing meetings, performance reviews, training, mentoring, etc.
  • Responsible for recommendations and selection of technological solutions and software to improve and/or maintain business standards
  • Perform cost-benefit and systems analysis for recommended solutions
  • Facilitate the requirements gathering, development, testing, change management, and implementation lifecycle

Technical Functions:

  • Provide subject matter expertise on all types of EDI X12 transactions, other standard formats such as HL7 and proprietary formats such as flat files
  • Develop appropriate controls for critical processes with all impacted systems
  • Develop EDI initiatives to implement Best Practices and improve overall EDI efficiency
  • Insure that all EDI transactions are HIPAA compliant
  • Responsible for converting business requirements into technical requirements
  • Identify project timelines and milestones and ensure deadlines are met.
  • Maintain documentation library and knowledge base articles to include training, trading partner specifications, website documentation, policies & procedures and ftp diagrams for all systems
  • Responsible for ongoing analysis and reporting of EDI related files, such as daily receipts, loading errors, fatal error counts, total claims and total dollars(as an example)
  • Analyze Trading Partner Fatal Errors to determine if improvements can be made
  • Other duties as assigned

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s Degree in Computer Science, Business Administration, Information Systems or related field

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Ability to plan, test, implement, and troubleshoot system software
  • Background in ANSI X12 formats such as 835s , 837s and 834s
  • Experience in supporting end-users in a corporate environment and excellent communication/teamwork skills
  • Experience with Project Management software
  • Familiarity with key Medicare and Medicaid managed care functions including claims, enrollment, and payment
  • Familiarity with ITIL standards
  • Knowledge and understanding of Protected Health Information (PHI)
  • Knowledge of hardware integration and configuration and network connectivity
  • Knowledge of health care related information systems and experience with high level programming is preferred in order to understand the effect a new implementation will have throughout all related systems
  • Previous Systems Management experience
  • Proficient knowledge of Microsoft Office products
  • Proficient knowledge of SSIS and SQL
  • Proven technical ability with Microsoft SQL Server 2005, Reporting Services
  • Strong documentation management and process flow experience
  • Strong leadership skills, excellent verbal and written communication skills beneficial
  • Understanding of Health Care Industry
  • Experience with Vendor Management
  • Must be available to work evenings and weekends during server upgrade and system maintenance

WORK BACKGROUND/EXPERIENCE

  • Minimum of 5 years working in Information Systems
  • Minimum of 3-4 years EDI Management experience in a business functional or technical environment
  • Minimum of 3-4 years’ experience in managing and supporting specialized applications

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position

 

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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