Manager - EDI
American Specialty Health Incorporated is seeking a Manager-EDI to join our Information Technology (ITD) department. This position will manage, direct and support a team of programmers and analysts to design, develop and implement transactions, mappings and reports to ensure compliance with HIPAA transaction set processing; design solutions to problems; direct and develop testing procedures for HIPAA transaction set processing; perform gap analyses and suggest resolution; direct and support and perform systems analysis and design solutions for timely loading of Health Plan eligibility, benefit and group information and streamlining reporting processes; manage and direct the timely Trading Partner submission of claims and claim encounter data. Also responsible for managing reporting functions, including performance standards, provider reporting, GEOACCESS, and accurate capitation exception reports. Responsible for standardizing and streamlining reporting processes and developing a solid reporting architecture that will support current and future needs.
American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, skill set, years of experience, and internal equity. $89,300 to $115,000 Full-Time Annual Salary Range
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).
Responsibilities
Manage transactional database programming and development.
Implement and manage EDI projects.
Manage and design the development of EDI tools to facilitate electronic exchange of transactional data between trading partners by creating standard formats for transmitting electronic HIPAA compliant transactions such as claims/encounters and enrollment.
Promote efficient and effective HIPAA compliance approaches and solutions.
Identify/document plans and implementation planning; create/update plans related to EDI implementation.
Promote efficient and effective HIPAA compliance approaches and solutions.
Design the implementation of EDI data transfers into organization’s operational systems.
Manage the development of EDI solutions to help reduce manual data entry.
Manage accurate standardized EDI, performance and provider reports for use by end-users.
Identify opportunities to specifically increase business efficiency through EDI.
Serve as an EDI/HIPAA expert for the organization.
Testing and implementation.
Redesign manage internal clearinghouse.
Work with implementation team to obtain electronic files from health plans and clients.
Work with client’s software development representatives to test and implement EDI transactions.
Ensure the quality and accuracy of inbound and outbound data.
Conduct timely annual performance reviews.
Attend scheduled operations, development, and other meetings to discuss issues and foster teamwork among department and operations personnel.
Qualifications
Bachelor’s degree or equivalent. High school diploma required.
5 years of progressive experience performing computer programming using Visual Basic and SQL in a network environment.
Solid, hands-on experience with multiple reporting tools.
Process oriented focused on standardization, streamlining, and implementation of best practices.
Experience with healthcare standard formats, X12, HIPAA Implementation Guides, etc.
Strong verbal and written communication skills.
Ability to translate business requirements to technical specifications.
Knowledge of business operations, database structures, transactional data processing and reporting solutions to meet business needs.
Core Competencies
Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
Ability to effectively organize, prioritize, multi-task and manage time.
Demonstrated accuracy and productivity in a changing environment with constant interruptions.
Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
Ability to exercise strict confidentiality in all matters.
Mobility
Primarily sedentary, able to sit for long periods of time.
Physical Requirements
Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility or work from home environment. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions
Work-from-home (WFH) environment.
American Specialty Health is an Equal Opportunity/Affirmative Action Employer.
All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.
#LI-Remote
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Manager - EDI
American Specialty Health Incorporated is seeking a Manager-EDI to join our Information Technology (ITD) department. This position will manage, direct and support a team of programmers and analysts to design, develop and implement transactions, mappings and reports to ensure compliance with HIPAA transaction set processing; design solutions to problems; direct and develop testing procedures for HIPAA transaction set processing; perform gap analyses and suggest resolution; direct and support and perform systems analysis and design solutions for timely loading of Health Plan eligibility, benefit and group information and streamlining reporting processes; manage and direct the timely Trading Partner submission of claims and claim encounter data. Also responsible for managing reporting functions, including performance standards, provider reporting, GEOACCESS, and accurate capitation exception reports. Responsible for standardizing and streamlining reporting processes and developing a solid reporting architecture that will support current and future needs.
American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, skill set, years of experience, and internal equity. $89,300 to $115,000 Full-Time Annual Salary Range
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).
Responsibilities
Manage transactional database programming and development.
Implement and manage EDI projects.
Manage and design the development of EDI tools to facilitate electronic exchange of transactional data between trading partners by creating standard formats for transmitting electronic HIPAA compliant transactions such as claims/encounters and enrollment.
Promote efficient and effective HIPAA compliance approaches and solutions.
Identify/document plans and implementation planning; create/update plans related to EDI implementation.
Promote efficient and effective HIPAA compliance approaches and solutions.
Design the implementation of EDI data transfers into organization’s operational systems.
Manage the development of EDI solutions to help reduce manual data entry.
Manage accurate standardized EDI, performance and provider reports for use by end-users.
Identify opportunities to specifically increase business efficiency through EDI.
Serve as an EDI/HIPAA expert for the organization.
Testing and implementation.
Redesign manage internal clearinghouse.
Work with implementation team to obtain electronic files from health plans and clients.
Work with client’s software development representatives to test and implement EDI transactions.
Ensure the quality and accuracy of inbound and outbound data.
Conduct timely annual performance reviews.
Attend scheduled operations, development, and other meetings to discuss issues and foster teamwork among department and operations personnel.
Qualifications
Bachelor’s degree or equivalent. High school diploma required.
5 years of progressive experience performing computer programming using Visual Basic and SQL in a network environment.
Solid, hands-on experience with multiple reporting tools.
Process oriented focused on standardization, streamlining, and implementation of best practices.
Experience with healthcare standard formats, X12, HIPAA Implementation Guides, etc.
Strong verbal and written communication skills.
Ability to translate business requirements to technical specifications.
Knowledge of business operations, database structures, transactional data processing and reporting solutions to meet business needs.
Core Competencies
Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
Ability to effectively organize, prioritize, multi-task and manage time.
Demonstrated accuracy and productivity in a changing environment with constant interruptions.
Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
Ability to exercise strict confidentiality in all matters.
Mobility
Primarily sedentary, able to sit for long periods of time.
Physical Requirements
Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility or work from home environment. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions
Work-from-home (WFH) environment.
American Specialty Health is an Equal Opportunity/Affirmative Action Employer.
All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.
#LI-Remote