Manager, EDI

🕒 April 22

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $130k - $135k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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Fallon Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1977

⚕️ Healthcare Insurance

💸 Finance

👥 B2C

Healthcare Insurance • Finance • B2C

Fallon Health is a health insurance provider that simplifies health coverage for individuals, families, and Medicare recipients. They offer a variety of health plans including Medicare and MassHealth, along with resources for members such as fitness reimbursement programs and member portals to track deductibles and manage claims. Fallon Health focuses on providing accessible healthcare options and support for caregivers, ensuring comprehensive care for their members.

📋 Description

• 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