Manager, EDI
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Job Description
Manager of EDI operations at Fallon Health ensuring efficient execution of all EDI functions. Overseeing EDI lifecycle, monitoring files, and acting as liaison with internal departments.
Responsibilities:
- 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:
- 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:
- Competitive salary
- Health insurance
- Professional development opportunities
- Paid time off
- Flexible work arrangements
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