Job Description

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.
• Prepare and deliver executive-level communications and facilitate meetings with internal and external stakeholders.

Knowledge, Skills & Abilities:

• 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.
• Strong working knowledge of Microsoft Applications (Excel, PowerPoint, Word, Outlook).

Education & Experience:

• 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.

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