Lead EDI Specialist
hace 12 días
Philadelphia
Position Title: Lead EDI Specialist Location: Philadelphia, PA (3 days/week onsite) Work Type: Contract to hire Overview: We are seeking a highly analytical and solutions-driven Lead EDI Specialist to oversee and support EDI enrollment operations for our Core Enrollment team. This role serves as both a technical subject matter expert and a team lead, ensuring that all EDI enrollment files (including 834 and alt 834 transactions) are processed accurately, reconciled efficiently, and delivered with exceptional quality. Key Responsibilities: • Lead reconciliation efforts for Core Enrollment Operations, ensuring all systems are accurately updated., • Review complex inbound 834 and alt 834 file issues in both pre-edit and post-release environments, developing best practices for analysis, reconciliation, and resolution., • Oversee production files for clients, ensuring successful transmission, validation, and follow-up on any discrepancies., • Manage the flow of inbound EDI files for client business, ensuring timelines and quality standards are met., • Act as a liaison between Core Enrollment Operations and other key groups (Vendors, UST, SDS, BTS, Compliance, Marketing, Client Implementation) on enrollment-related initiatives., • Serve as the subject matter expert (SME) for group requests and coordinate technical and process changes., • Document and prioritize system limitations; collaborate with BTS to identify and implement technical solutions or automation opportunities., • Lead resolution efforts for enrollment-related issues in the Enrollment Resolver Group., • Organize and distribute project and operational work among a team of 16, providing guidance, feedback, and support., • Develop and maintain procedures, job aides, DLPs, service alerts, and policies for enrollment processes., • Manage initial enrollment file loads for new client installations., • Provide coaching, training, and technical assistance to team members; serve as a resource for less experienced colleagues., • Conduct data analysis and maintain accuracy of internal trackers to monitor productivity and timeliness., • Lead or contribute to special projects and automation initiatives, including managing Robotic Process Automation (RPA) activities for the business area., • Deep understanding of EDI systems and HIPAA 834/ANSI X12/XML enrollment transactions., • Proven ability to coordinate and manage end-to-end enrollment processes., • Strong analytical and data management skills, including proficiency with Excel (pivot tables, data analysis, advanced functions) and SQL., • Experience maintaining and updating trackers, ensuring client deliverables and timelines are met., • Excellent verbal and written communication skills with the ability to interact confidently with leadership and external clients., • Demonstrated experience in training, mentoring, and process improvement., • Exceptional time management and prioritization skills; able to thrive in a fast-paced environment., • Proven ability to manage multiple projects simultaneously while maintaining quality and accuracy., • Bachelor’s degree in Business, Information Systems, or a related field preferred (or equivalent experience)., • Minimum of 5 years of experience in healthcare, with a focus on EDI or enrollment operations., • At least 2 years of lead or supervisory experience managing team workflows and performance., • Demonstrated experience in data analysis, process improvement, and client-facing communication.