Full Time Remote Claims Jobs in Raleigh, NC (NOW HIRING)

The Manager of EDI Development and Support’s primary role is to oversee the development, implementation, and support of our EDI systems, processes and vendor interactions and support. The Manager of EDI Development and Support will collaborate with cross-functional teams, manage EDI projects, and ensure seamless electronic data exchange with our partners and customers. This individual should have a strong technical background in EDI, excellent leadership skills, and a deep understanding of business processes and integration.

This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed.

Responsibilities & Duties

Program Management

• Lead and manage the EDI development and support team, providing guidance, mentorship, and technical expertise
• Oversee the design, development, and implementation of EDI solutions, ensuring compliance with industry standards and business requirements
• Collaborate with cross-functional teams, including IT, operations, and business analysts, to gather requirements, define EDI processes, and establish integration points
• Manage EDI projects from initiation to completion, including project planning, Team resource allocation, and monitoring project timelines and deliverables
• Coordinate with external trading partners to establish EDI connections, document requirements, and facilitate testing and certification processes
• Develop and maintain EDI maps, transformations, and data mappings to enable seamless data exchange between internal systems and external partners
• Ensure the reliability, availability, and security of EDI systems, and proactively monitor system performance, troubleshoot issues, and implement corrective actions in conjunction with the appropriate IT resources
• Stay updated with EDI standards, industry trends, and emerging technologies, and propose new and innovative solutions to improve EDI processes and enhance data exchange capabilities
• Provide technical expertise and support to resolve complex EDI-related issues, and serve as an escalation point for EDI production support tickets
• Prepare and present regular reports and updates to IT management, highlighting project status, key performance indicators, and recommendations for improvement

Implementation, Monitoring and Support Activities

• Supervise the development, testing, implementation and ongoing maintenance of the HIPAA 837 claims, 835 remittance, 834 eligibility, 999 response and other EDI files
• Monitor and provide support to all EDI production processes and support for all trading partners
• Support the design and maintenance of all EDI maps to ensure compliance to all business and State requirements
• Analyze all EDI implementations and recommend improvements to processes and coordinate with trading partners to resolve all issues effectively
• Supervise the running and processing of all EDI services from and to various trading partners based on our corporate schedules
• Work collaboratively with internal departments to ensure the HIPAA transactions are provided to the trading partners timely and all reported failed records are corrected and resubmitted by the trading partner
• Review and process all rejection reports associated with daily remittance files, correct rejected transactions and resubmit the transaction. Work with trading partners to resolve any operational issues
• Document, track, monitor and escalate support requests to ensure resolution within 72 business hours per the State contractual SLA requirements
• Develop and maintain EDI Companion Guides and working with Trading Partners to meet these standards
• Interface with providers, vendors and internal departments to provide first level support and to address technical and procedural issues related to EDI
• Support the present business practices and processes and find ways to improve them through a continuous performance improvement review

Minimum Requirements

Education & Experience

Required:

Vocational and or Technical Training in EDI, computer science or a related field and at least seven (7) years of experience working in an EDI or Business Analyst related field.

Preferred:

Experience working with healthcare data is highly preferred.

Knowledge, Skills, & Abilities

• Proven experience in EDI development, implementation, and support, preferably in a managerial role.
• Strong technical proficiency in EDI standards and protocols (e.g., ANSI X12, EDIFACT) and hands-on experience with EDI translators and communication protocols (e.g., AS2, FTP, SFTP).
• Solid understanding of business processes and integration with EDI.
• Experience with understanding and developing EDI mapping and Companion Guides.
• Strong SQL skills and knowledge.
• Strong communication and interpersonal skills, with the ability to collaborate effectively with technical and non-technical stakeholders.
• Highly proficient in querying databases directly, including the ability to query, compile, and manipulate large datasets.
• Strong leadership and people management skills, with the ability to inspire and motivate a team.
• Ability to work independently and make continual progress while managing multiple projects and priorities.
• Strong Analytics and/or Project Management skills.
• Strong problem solving and analytical  skills.
• Strong understanding of data quality concepts, principles, and best practices. 

Employment for this position is contingent upon a satisfactory background and credit check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. 

Salary Range 

$105,497-$134,508/Annually 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:  

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility