Job Summary
The Specialist, EDI Operations & Transactions Management, Provider Connectivity Solutions role applies their discipline-specific knowledge of Electronic Data Interchange (EDI), X12 & HL7 standards and CMS/ONC Regulatory Compliance or institutional knowledge and skills in the performance of departmental activities which support the operations of the CompanyThe primary function of the role is applying specialized knowledge and skills as an exempt-level individual contributor. This role performs activities that support the success of our Provider Experience, data workflow operations and the Provider Network scorecard. Supports and contributes to the Provider Connectivity Solutions strategy.

Essential Functions

• Research, analyze, maintain, modify, validate, and prepare Provider, Trading Partner Electronic Transaction, 3rd Party Application Developer and/or EMR vendor/Integrator encounter data, information and content used in making business decisions. Output is used for problem solving, forecasting, costing, planning, positioning, trending, measuring, controlling risk, contracting and administration.
• Utilize advanced technical tools such as IBM Data Studio, Toad for Oracle, Edifecs Transaction Manager for daily operational functions
• Monitor, maintain and test the Company's systems that manage business and work processes.
• Research, analyze, synchronize, maintain, modify, interpret, validate, and prepare data, information and content used in making business decisions. Develop tools and systems to manage this information.
• Help clients understand and comply with internal and external standards and practices. Identify risks, evaluate controls, and prepare findings and recommendations. Implement compliance programs to prevent illegal, unethical, or improper business practices.
• Monitor and evaluate the effectiveness of solutions, policies, practices, and processes to ensure continuous improvement, good client relations, compliance and adherence to business and system requirements. Recommend improvements to achieve and deliver high quality, value-added services.
• Administer programs that meet business needs; may assist with program development and enhancements.
• Ensure through audits that the organization's programs are consistently administered in compliance with organizational policies and procedures, contractual obligations, rulings, laws, and government regulations as applicable.
• Coordinate, produce, and distribute a variety of business documents such as reports, system and process documentation, audit results, newsletters, brochures, etc.
• Translate business needs and deliverables into technical specifications and requirements.
• Engage with director-level leadership on work deliverables, status communications and escalated issues.
• Support, participate in, or lead smaller to mid components of projects. Carry out tasks and activities that support project plans and deliverables.
• May participate in department/divisional workgroups and initiatives.
• May participate in Industry workgroups and standards organizations (webinars, listserves, summits) such as; X12, HL7, WEDI, eSolutions Xchange, HIMSS, Availity Connects

Qualifications

Qualifications

* Required Work Experience
4+ years related work experience. Experience Details: Healthcare, Analytics & Reporting, Data Issue Management, Project/Product Owner

* Required Management Experience
No supervisory/management experience required

* Required Education
Related Bachelor's degree or additional related equivalent work experience

* 2+ years working experience with technology vendors specialized in Interoperability and/or Electronic Data Change and/or Data ingestion/presentation such EMR vendors & Integrators (e.g., Athena Health, Epic, MediVu, VIM), Provider Engagement Platforms and API channels (e.g., Availity, Change Healthcare)

* 2+ years experience managing technology vendor relationships; RFI submissions, Reviewing/Redlining MSA/SOWs, contract negotiations, SLA monitoring and enforcement

* Experience managing tasks independently and take ownership of responsibilities.

* Thorough knowledge of Information Technology fields and computer systems

* Experience learning from mistakes and applying constructive feedback.

* Experience communicating technical information clearly and articulately.

* Ability to adapt to a rapidly changing environment.

* Experience with Product Management - Product Discovery, Planning & Development

* Experience with business requirements and business process analysis to ensure IT solutions meet the business needs and Thorough knowledge and experience of systems, subsystems, development methodologies, systems architecture, tools, and processes that support the assigned business initiative or system

* Understanding of and Agile processes and disciplines

* Understanding of typical architecture standards and ability to apply them in their design work -

* High critical thinking skills to evaluate alternatives and present solutions that are consistent with business objectives and strategy.

* Knowledge of systems development concepts and methods - Experience in applying research methodology to business solutions.

* Ability to lead and facilitate project team status meetings to obtain schedule, issues, risk , and dependency updates.

* Ability to document meeting minutes, action items from project status meetings.

* Ability to organize and prioritize workload.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, Short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan includes employer contribution and employer match;
• Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $68,100 - $110,600

Typical Annualized Hiring Range: $68,100 - $85,100

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.