Job Description

Job Summary
This individual will play a critical role in overseeing and managing key initiatives related to their Edifecs upgrade as well as leading the evaluation and optimization of EDI 275 transactions. Prior experience with FACETS-integrated EDI workflows will be key.


Primary Responsibilities

• Serve as the Project Manager for the Edifecs upgrade project, ensuring milestones, deliverables, and timelines are met.
• Lead the evaluation and assessment of the organization's EDI 275 transaction processes (attachments), recommending improvements and coordinating implementation efforts.
• Collaborate with cross-functional teams including IT, business operations, vendors, and compliance to ensure alignment and successful execution of project goals.
• Develop and maintain detailed project plans, status reports, risk logs, and communication updates for leadership.
• Ensure adherence to HIPAA, healthcare EDI standards, and payer industry best practices.
• Manage vendor relationships, coordinate testing activities, and oversee change management efforts.
• Support integration points with FACETS and other enterprise systems as it relates to EDI transaction processing.

Education and Experience

• 5+ years of experience as a Project Manager within healthcare payer/insurance, with a focus on EDI transactions and systems.
• Strong knowledge of Edifecs platform and healthcare EDI transactions, particularly 275s (attachments).
• Proven ability to manage complex, multi-stakeholder projects in a health plan environment.
• Excellent organizational, communication, and leadership skills.

Job Tags

Remote work,

Similar Jobs