EDI Lead

ROLE OVERVIEW

We are looking for a highly motivated, independent, and organized EDI Lead with strong communication and problem-solving skills to maintain the quality of inbound and outbound Electronic Data Interchange (EDI) files, including ANSI X12, 834 files, flat files, and IEEE formats, through review of each file and any reported discrepancies. The ideal candidate brings a keen eye for detail and a dedication to upholding and enhancing quality standards.

KEY RESPONSIBILITIES:

- The essential functions include, but are not limited to, the following: EDI Quality & File Processing
- Monitor all EDI file processing for quality and troubleshoot and resolve all transaction file issues.
- Monitor, track, and update data required for file transmission. n Consistently maintain standards for monthly quality.
- Work directly with vendors and carriers on new and changed file requirements, both inbound and outbound, from initiation to implementation.

Process Improvement & Documentation

- Identify and report issues and opportunities for improvement related to processes and procedures.
- Develop and maintain documentation related to EDI processes, including reports, metrics, and improvement plans.
- Own team improvement initiatives and Knowledge Base maintenance.
- Stay updated on industry standards and regulations related to US healthcare and EDI.

Team Support & Collaboration

- Assist internal and external teams with any queries regarding file transactions.
- Assist the EDI team with process questions and escalated issues.
- Participate in meetings as needed.
- Support and sustain a positive work environment that fosters team performance through own work and behavior.
- Perform special tasks and assignments as needed

Requirements

Education & Experience

- Bachelor's/College Degree in any field; an equivalent combination of education and/or experience will be considered.
- At least 5 years of prior experience in quality assurance.
- At least 5 years of prior experience with EDI formats, including mapping new files.
- 1–2 years of experience with SQL.
- Experience serving international customers. n Working knowledge of HIPAA EDI protocols.

PREFERRED QUALIFICATIONS

- 3 years of work experience specializing in US health insurance, customer service, or third-party administration.
- Familiarity with US healthcare industry standards and regulations related to EDI.
- Experience working directly with vendors and carriers on EDI file implementations

Skills & Competencies

- Detail-oriented with a focus on continuous improvement and problem-solving.
- Excellent planning and organizational skills, with the ability to effectively manage multiple tasks to completion.
- Proficient in Microsoft Office (Word, Excel, Teams, Outlook).
- Strong interpersonal skills, with the ability to effectively work and collaborate with individuals or groups at all organizational levels; able to work independently and as part of a team.
- Ability to maintain confidentiality of sensitive information
- Minimum of 4 years of experience in the BPO/call center industry