The Manager, EDI, Environment/Release Management department is responsible for the effective management of EDI, PPO and Release Management related activities, including installing software service packs, electronic file exchanges, and upgrades of applications/software used to support PriMed claims processing and eligibility management.
S/he will be responsible for the EDI staff to support enrollment and claims file loading and high data quality encounter file submissions as per compliance timeframe. S/he will be responsible for leading the staff supporting QNXT regions and environment management; the PPO, eVIPs, ClaimCheck/ClaimsXten upgrades and service pack management as well as those identified applications that are used at PriMed to support claims processing, eligibility, authorization and provider management.
- Develops and maintains complete documentation of HMO, PPO EDI claims and eligibility file loads
- Develops and maintains calendar of release management per ITIL standards
- Create and execute test scripts utilizing department approved templates for validation
- Effectively communicate issues and defects to technical and non-technical stakeholders. Analyze impact and escalate defects that will impede forward progression on the project.
- Work with end-users, subject matter experts, vendors, project managers, project analysts, and developers to investigate defects and ensure that they are satisfactorily resolved.
- Work closely with project managers to complete QA activities within project timelines.
- Maintains a knowledge base with a thorough understanding of the range of applications and tools used throughout the organization and how they affect business operations.
- Keep Senior Management informed and mentor and manage team performance.
- Serve as key contact to PriMed/Hill user, community, and support/data vendors in defect identification and resolution.
- Support management in recommending process enhancements and analyze new procedures to enhance efficiency.
- Participate and lead staff, team, and planning meetings.
- Other duties as assigned.
- Release management ITIL knowledge is a plus.
- EDI and QNXT configuration knowledge highly desired.
- Minimum seven years of experience in software applications support, preferably in Healthcare.
- Minimum seven years of experience in healthcare information systems development and support.
- Excellent written, verbal and interpersonal communication skills required.
- Ability to work well with business and technical staff and all levels of management.
- Ability to exercise good judgment, prioritize multiple tasks and problem solve under pressure of deadlines and resource constraints required.
- Strong analytical and problem solving skills required.
- Knowledge of relational database, query language, MS SQL, Access, Excel, Various OS concepts, and programming concepts highly desired.
- Minimum years 7 of experience preferred
- Bachelor’s Degree
- BS in Computer Science, MIS, Healthcare or related field or equivalent education and experience.
Hill Physicians is an Equal Opportunity Employer
Must be eligible to work in the U.S. without Visa Sponsorship
For more information, please visit www.hillphysicians.com and instagram.com/people_make_primed