EDI Lead - Remote

Job Summary
The EDI Lead manages and is responsible for the overall EDI/Interoperability process. This position is responsible for managing, planning, and guiding daily EDI operations and ensuring that trading partners, contracted networks, hospitals, government agencies, and provider transactions (X12, HL7, NCPDP, Proprietary, FHIR) are compliant with HIPAA, CMS, DHCS, and DMHC mandates, regulations, and policies.
This role serves as a liaison between internal business units for all EDI/Interoperability requirements, including eligibility, provider data, claims, clinical data, and encounters. The EDI Lead also develops and provides oversight of EDI/Interoperability processes and documentation and is responsible for all EDI/Interoperability-related projects. The position manages EDI priorities and assignments in coordination with IT Applications Managers and the Director.
Knowledge, Skills, and Abilities
 

• In-depth knowledge of HIPAA/EDI X12 5010 healthcare file formats
   
• Knowledge of HL7 and FHIR formats
   
• Strong data analysis and discrepancy resolution skills
   
• Ability to work independently and in team environments
   
• Strong verbal, written, and oral communication skills
   
• Advanced analytical and problem-solving skills
   
• Proficiency in English grammar, editing, and proofreading
   
• Demonstrated leadership and cross-functional coordination skills
   
• General PC and Microsoft Office proficiency
   

Education and Experience
 

• Bachelor’s degree or higher, or equivalent industry experience
   
• 5–7 years of experience as an EDI Analyst
   
• Experience with QNXT and/or other Cognizant solutions
   
• 5–7 years of experience with Edifecs products (preferred)
   
• Strong MS Office skills (Outlook, Word, Excel, PowerPoint)
   
• Healthcare organization or health plan experience preferred
   
• Experience implementing new systems preferred
   
• Familiarity with healthcare, managed care, or Medi-Cal terminology preferred