Vice President, EDI Services (Electronic Data Interchange) in Boston, MA at Beacon Health Options

Date Posted: 4/27/2018

Job Snapshot

Job Description


We are currently seeking a dynamic Vice President, EDI Services to join our team at our office in Boston, MA or Latham, NY.  The VP, EDI Services will be dedicated to the development, implementation, adoption and support of EDI capabilities to drive administrative efficiency and improved business performance. Owns and oversees
the Electronic Data Interchange (EDI) business strategy, the adoption of EDI interactions with external constituents and the definition of new electronic-based capabilities. In addition, the VP of EDI Services will also support continuous improvements to  existing EDI Operations,   guide day to day work activities and oversee project management of Beacon EDI initiatives. This role will also be responsible for managing strategic EDI vendor relationships, vendor operational metrics and overall contractual agreements.

Position Responsibilities:

  • Provide governance and interact with staff to define all aspects of EDI capabilities, implementations, trading partner management, business process improvement, and EDI issue escalation/production support.
  • Develop and maintain Beacon’s overall EDI strategy and measurements/metrics for the transition of business exchanges to electronic-based interactions
  • Responsible for the oversight and management of all EDI production operations activities, including documentation, quality assurance, implementation support, and workflow management.
  • Provide direct guidance to the management and staff of EDI Operations teams.
  • Responsible for the management and maintenance of the EDI operationss issues backlog, including the governance, timely reporting, communication to internal and external stakeholders, and risk management of all issues
  • Provide oversight for the configuration of EDI trading partners within multiple technology platforms in line with business objectives.
  • Champion the implementation of direct electronic claim submissions and electronic funds transfers with Beacon Providers.
  • Maintain documentation and web site content for all EDI related interactions with Beacon Health Options
  • Provide communications and updates regarding Beacon EDI programs to all submitters, external partners and healthcare Providers.
  • Financial management responsibility for an operating budget of approximately $10M
  • Ownership and realization of the overall business case for EDI
  • Identification of operational efficiencies and improvements through the use of EDI
  • Responsible for driving Electronic Data Interchange (EDI) compliance with our external vendors, claim submitters and healthcare Providers. This includes but is not limited to transitioning legacy files to current version of HIPAA X12 transactions, reducing or eliminating paper submitted claims and correspondence and transitioning to electronic-based payment methods.
  • Represent Beacon Health Options with external EDI user groups, consortium groups and standards bodies as needed.

Position Requirements:

Education :  Bachelor’s degree (required); Master’s Degree in related areas is a plus

Licensure :  None required

Relevant Work Experience:    8+ years of management experience, especially in a Healthcare setting, or EDI related setting  10+ years’ experience working in a managed care/services environment, preferably in a Health Maintenance Organization setting.  Demonstrated record of accomplishment guiding cross-functional teams to successful project completion: on time, on budget, and on plan

Knowledge, Skills & Abilities :

  • Functional familiarity with commonly used EDI and digital business processing  concepts, practices and procedures within a heath care environment
  • Possess a strong knowledge of claims, enrollment, and related business processes in a commercial, Medicare, or Medicaid health plan organization
  • Working knowledge of EDIFECS system(s) a plus.
  • Knowledge of relevant regulatory requirements including but not limited to Title XXII, Title XXVIII, HIPAA, ICD-10, the Affordable Care Act and HITECH.
  • Excellent verbal and writing communication skills – communicates successfully in technical, non-technical, and user-friendly terms
  • Self-motivated and able to work independently in a dynamic, fast-paced environment
  • Demonstrated history of excellent leadership, communication, and interpersonal skills coupled with strong customer driven orientation
  • Ability to effectively communicate with multiple levels of personnel both verbal and written
  • Detail-oriented and ability to multi-task to meet constantly shifting work demands


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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled