Manager, EDI

Fallon Health

. Manage, plan, and direct the daily operations of the EDI Department to ensure accurate, timely, and efficient execution of all EDI functions across Fallon Health .

Posted 4/22/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesSeniorLead💰 $130,000 - $135,000 per yearWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Manage, plan, and direct the daily operations of the EDI Department to ensure accurate, timely, and efficient execution of all EDI functions across Fallon Health
Accountable for ensuring the EDI team operates at peak effectiveness
Oversee the end-to-end EDI lifecycle for the organization, including tracking incoming and outgoing EDI files and monitoring unsuccessful transmissions
Provide oversight of EDI claims reconciliation processes to ensure accuracy
Act as a liaison between EDI, IT, Configuration, and other internal departments to resolve day-to-day operational issues

Requirements

What you’ll need

Bachelor's Degree required
7+ years of experience in the operational environment of a Managed Care Organization (MCO)
Extensive Experience with HIPAA compliant transactions and applicable platforms such as Edifecs and BizTalk required
Extensive EDI experience, including regression testing, SNIP level validation, and transaction testing
QNXT experience required (hands-on, operational)
Basic SQL skills required for troubleshooting, data validation, and issue analysis
Strong knowledge of EDI production environments and workflows
Familiarity with change management and release coordination

Benefits

Comp & perks

Competitive salary
Health insurance
Professional development opportunities
Paid time off
Flexible work arrangements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

EDIHIPAA complianceSQLregression testingSNIP level validationtransaction testingchange managementrelease coordinationdata validationissue analysis

Soft Skills

managementplanningdirectionoversightliaisonproblem-solvingteam effectivenesscommunicationoperational efficiencycollaboration