Manager, Healthcare EDI Services in Coral Gables, FL at Beacon Health Options

Date Posted: 3/12/2020

Job Snapshot

Job Description

The Manager, Healthcare EDI Services is responsible for the supporting short and long-term operational and/or strategic business initiatives and managing and improving the company’s Electronic Data Interchange (EDI) Client Services processes within the scope assigned.

Work closely with other business areas to improve data quality and achieve contractual service levels from our clients and partners. Primary responsibilities include leading a team of developers and analysts who root cause and fix issues preventing encounters data from being accepted. Monitoring of all EDI Client Services related requirements and work to implement operational and/or technical changes or improvements necessary. Implement medical expense initiatives relating to encounter data submissions.

Working in a highly matrixed environment, the Manager, Client Data Services will need to, directly and indirectly, guide team members, consult and create partnerships with business colleagues and have the leadership skills to influence outcomes. In providing insights, visualizations, and actionable business dashboards, the Manager, Client Data Services will interface directly with all levels of leadership across the Beacon Health Options Enterprise, while also having direct client interactions and relations. This position does require occasional overnight travel.

Responsibilities:

  • Manage and provide daily supervision of personnel, which includes work allocations, make recommendations for personnel actions and approve motivational plans and/or programs for individual development in order to operate at peak productivity and profitability
  • Works on complex issues where analysis of situations or data requires an in-depth knowledge of the company and its functions.
  • Develops and analyzes metrics, measurements, and reports needed to help drive client operations and EDI strategic plan.
  • Conduct and manage the routine financial reconciliation of encounter data submissions and dollar amounts for the over 1 billion dollars of Encounter submissions managed by Beacon Health Options
  • Develop dashboards and insights to manage the impact of encounter data on risk adjustment and premium revenue to our clients.
  • Ensure compliance with federal and state contractual needs and reporting requirements by performing data quality audits and analysis.
  • Collaborate with internal support teams and regional teams to troubleshoot issues and design creative solutions.
  • Manages relationships and execution with business leaders ranging from Manager to Sr. Director level.
  • Sets overall goals, performance standards, and operational priorities for one or more functions and manages resources to operational and financial goals.
  • Drives operational and/or technical project estimations, feasibility assessments, prioritization, and resource management activities.
  • Manage the data file exchange and report distribution methods and processes between customers, vendors and our company.
  • Develops and analyzes metrics, measurements, and reports needed to help drive client operations and CDS strategic plan.
  • Provision, certify and enable access to Edifecs and other EDI related information.
  • Develops and deploys dashboards, data visualization and autonomous and dynamic reports using various technologies.
  • Research regulatory and contract requirements.
  • Examines the needs and concerns of analytical leads to determine opportunities or problem areas and provide feedback regarding the development of applicable policies, procedures,
  • methods and/or standards.
  • Develops automated solutions for reporting, ad-hoc projects and longstanding processes.
  • Leads in the development of KPI tools and alerts that will use live data aligned with EDI's initiatives and interventions to help units stay on track towards achieving metric goals, preeminence, and strategic initiatives.
  • Collaborates with business partners in the management of vendor relationships which include all vendor Encounter submissions.
  • Works closely with Information Technology to meet all regulatory and business requirements regarding encounter submissions and/or data management.
  • Works with all business units to improve and enhance data management practices.
  • Manage Encounters business requirements and UAT testing strategy and implementation.
  • Undertake additional duties as required by the company.

Requirements:

  • Minimum of 4 years’ experience in relevant area required
  • At least 1-year experience supervising staff preferred

Education:

  • Bachelor's degree in Computer Science, Information Management, Business, or a Healthcare related field.
  • 4 years of relevant experience in lieu of degree accepted

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

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