Manager, Electronic Data Interchange

Job Category: Management/Executive

Department: Claims Data and Support Services

Location:

Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 9464

Salary Range: $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Manager of Electronic Data Interchange (EDI) leads and manages the EDI Business Analysts in the completion of strategic day-to-day operations and process improvement re-engineering efforts to ensure all EDI business activities are efficient and streamlined. Effectively manages business workflows, functional/technical requirements, and reporting requirements for all HIPAA X12 EDI transaction workflows. The Manager will be responsible for managing business relationships with both its internal and external business partners. This includes oversight of the team's relationships with it's vendors and adhering to industry standard requirements. The Manager will be responsible for keeping up to date with industry standard change requirements that impact EDI business transactions and working cross functional with its leadership team to strategize, document, and successfully implement changes. The Manager will also be responsible for supporting, guiding and monitoring business analyst in the implementation of key department projects from conception through implementation. This position will perform process improvement analysis to identify potential business inefficiencies and work with corresponding business partners to identify opportunities for improvements; develop solutions, and implement timely to maximize organizational efficiencies, minimize waste and improve quality and overall experience for it's customers. This position manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties

Plan, organize, direct, staff, and develop activities of assigned functional areas(s). Contribute expertise and specialized knowledge to work activities. Manage, coach and mentor business analysts for improved functions as-needed. Monitor daily production and ensure that the work produced by the team is consistently of high quality. Ensure business activities are properly functioning ranging from intake and output of all EDI transactions through implementation of key small and large size projects.

Collaborate with cross functional team to analyze and validate reported issues, which includes identifying root cause and propose solutions while considering critical factors that will allow the organization to move forward with a solution in place that focuses on addressing business inefficiencies; systems and otherwise.

Manage the business, functional/technical, and reporting requirements of operations and business projects effectively. Manage the creation, distribution, validation and approval of all requirements and process redesign deliverables. Oversee all EDI functions and process improvement re-engineering initiatives to ensure that team works with cross-functional business partners to identify potential business inefficiencies, considers redesign opportunities, develop solutions, and implement time process improvements.

Develop and maintain effective communication mechanisms at various levels of the organization and with external entities. Build and maintain key relationships with internal and external stakeholders to accomplish objectives.

Oversee and monitors operational compliance with organizational standards, policies and procedures, regulatory requirements and financial controls. Concisely, clearly and formally communicate complex concepts and formulate solutions. Prioritize effectively and meet deadlines while managing multiple, competing tasks.

Manage staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Perform other duties as assigned.

Duties Continued

Education Required

Bachelor's Degree

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

In lieu of degree, equivalent education and/or experience may be considered.

Experience

Required:
At least 6-8 years of data analysis experience in a health or managed care environment.

Minimum of 3-5 years of supervisory/management experience in a healthcare setting, preferably in a setting involving recent migrations or system implementations.

Skills

Required:
Thorough knowledge of Healthcare data elements required including basic understanding of all HIPAA EDI Transactions (837P, 837I, 835, 270/71, 276/277, 834, 278).

Basic knowledge of Commercial Plan line of business policy and business requirements to help support the implementation of the Accumulators project which includes the documentation of processes and control, analysis, business operations, and oversight of day-to-day activities.

Ability to maintain an up-to date knowledge of Information Systems and EDI transactions to develop, execute, and improve correction action plans by providing subject matter expertise and guidance to best business practices.

Ability to utilize formal and informal written communication methods (BRDs, FRDs, email, PowerPoint presentations, Visio workflow, executive summaries, and project logs)

Ability to interpret and apply complex operating instructions, state and federal regulations, and department/division procedures. Ability to understand, apply, and communicate rules, regulations and guidelines to others.

Ability to perform extensive root cause analysis of problem areas an recommend alternative solutions.

Excellent communication skills, strong analytical and coaching/mentoring skills, team building skills and the ability to work effectively with diverse team members.

Must be able to work in an environment where critical time constraints exist.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, it's expected that all employees wear a mask in areas where physical distancing cannot be managed.