EDI Manager

JOB SUMMARY:

Support core and surround applications and systems used by the claims department.  Works with ITS in the development of enhancements to systems or surround applications as well as support testing related to any changes to any front end processes and systems.  Responsible for maintaining several Sarbanes-Oxley controls as well as enhancing these controls as necessary to ensure all goals of Sarbanes Oxley are met.

 

 

PRIMARY RESPONSIBILITIES: 

?  Manage and maintain all MACESS.exp Doc-Flo systems

?  Support growth within MACESS.exp by providing technical expertise of the product to the Business

?  Administer security and profile management on all applicable systems within Service Operations.

?  Support EDI activities and initiatives by providing technical oversight of existing and emerging transactions within the industry.

?  Formulate recommendations on alternative approaches to realize desired functionalities and/or enhancements to existing systems thereby achieving desired levels of performance.

?  Prepare acceptance test plans, conducts acceptance tests and confirms results on all enhancements and maintenance system modifications.

?  Operate under deadlines while managing multiple projects concurrently.

?  Act as project manager on tasks specifically related to the department whenever necessary.

?  Oversight of monthly vendor reconciliation of EDI invoices to ensure EDI expenses are accurate.

?  Oversight of daily reconciliation of the EDI and MACESS loads into the various host systems to ensure the Sarbanes Oxley controls are functioning as designed.

? Maintain strong working relationships with internal and external customers.

?  Other Duties as Assigned

 

Education and Experience:

Education

Required: BS in Health Information Sciences, Information Technology, Computer Science or a related discipline, or the equivalent combination of work experience and technical training. 

Preferred: 

Years and Type of Experience  

Required:  

?  Minimum of 5 years EDI experience with at least 3 years in systems management and/or work in an analysis or technical production capacity in a managed care environment.

?  Thorough understanding and previous experience with project management tools and methodologies.

Preferred:

?  General understanding of non-claim EDI transactions

Specific Technical Skills

Required:

?  Advanced level MS Office Skills (Access, Excel, Power Point, Word)

?  Strong working knowledge of electronic claims submissions and HIPAA transaction sets.

?  Advanced understanding of Access Query design, reporting and navigation.

?  Strong Understanding MACRO and Programming concepts

?  Strong understanding of MACESS.exp administration

?  Understanding of common claim coding (CPT-4, ICD9, HCPCS).

?  Understanding of HCFA 1500 and UB92 claim billing forms.

?  Understanding of claim processing and related systems/applications.

?  Ability to accurately interpret and understand EDI Concepts and process flows.

?  Ability to do root cause analysis and make recommendations for process and policy improvements.

Preferred:

?  Previous experience in working with AMISYS, FACETS and/or TXEN processing systems.

?  Experience with Direct Submission concepts

?  Security profile maintenance and administration across multiple platforms

Certifications or Licensure

Required:

Preferred: 

Other

Required:

?  Strong interpersonal skills

?  Demonstrates initiative; is proactive in problem resolution; ability to multitask

?  Able to work independently and use reference material to resolve claims/EDI related questions.

Preferred:

PHYSICAL REQUIREMENTSMust be able to operate a computer, telephone, fax and copier

?  Standing and sitting for long periods of time.

?  Data Entry using repetitive motions of fingers and forearms.