Lead and optimize the day-to-day operational, analytical, and technical functions that support electronic data exchange
Manage end-to-end operational oversight of inbound and outbound HIPAA-standard and proprietary EDI transactions
Ensure timely, accurate, and compliant processing of electronic claims, encounters, eligibility updates, and related administrative data
Oversee transaction monitoring, exceptions, error queues, and data rejects; ensure prompt triage and resolution
Provide oversight of requirements documentation, including business and functional requirements (BRDs/FRDs), workflow mapping, and data specifications that support operational effectiveness
Manage complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval
Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals.

Requirements

Bachelor's Degree
6+ years of experience working with healthcare data, EDI transactions, claims data operations, or managed-care administrative systems
5+ years of experience in leading, supervising and/or managing staff
Experience with system integrations, data migrations, or large-scale technical implementations
Demonstrated experience leading complex issue resolution and root cause analysis efforts
Strong knowledge of HIPAA-standard EDI transactions and healthcare data structures
Knowledge of MOOP accumulators, authorization workflows, and EOB data flows
Proficiency in SQL, Access, Excel, and related reporting or analysis tools
Ability to interpret and produce BRDs, FRDs, process flows, and technical documentation.

Benefits

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills

EDI transactionsHIPAA complianceSQLAccessExceldata migrationssystem integrationsroot cause analysisrequirements documentationworkflow mapping

Soft skills

leadershipproject managementstakeholder engagementproblem-solvingcommunicationaccountabilitycontinuous improvementtransparencyteam managementorganizational skills

Certifications

Bachelor's Degree