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EDI and Release Management Manager

Hill Physicians Medical Group, Inc. San Ramon Full-Time
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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.

Job Responsibilities

  • 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.

Additional Responsibilities

  • 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.

Required Experience

  • Minimum years 7 of experience preferred

Required Education

  • Bachelor’s Degree
  • BS in Computer Science, MIS, Healthcare or related field or equivalent education and experience.

Additional Information

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

Skills required

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Hill Physicians Medical Group is the largest independent physician association in Northern California and is a nationally known leader in innovative healthcare. Since 1984, we have been providing the communities we serve access to quality healthcare. The over 4,000 physicians who comprise Hill Physicians Medical Group provide care to our Commercial HMO, Medicare Advantage, Medi-Cal and PPO attributed members.

PriMed Management Consulting Services is the management services organization for Hill Physicians Medical Group. The employees of PriMed provide technology, financial, clinical support and business services to the physicians comprising Hill Physicians Medical Group.

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