Healthcare Claims EDI Manager Location:

St. Louis, MO (Westport) | 100%

In-Office Schedule:

Monday-Friday, 8:00 AM-5:00

PM Salary:

DOE Benefits:

401(k) + Match, Medical, Dental, Vision, FSA, PTO and Life Insurance Why HPC? Health Payer Consortium is a growing healthcare cost-containment company with a culture that looks a little different from the typical healthcare organization.

• Approximately 65 employees
• Only three employees have voluntarily left HPC in the past five years
• Over the last 12 years, HPC has roughly doubled revenue, EBITDA and employee count every other year
• Our U.S. expansion represents our largest growth opportunity, with a self-funded healthcare market approaching $1 trillion
• Our international business continues to grow throughout the Caribbean and Latin America
• We work hard, move quickly and believe people can do meaningful work without creating a buttoned-up corporate environment What We Do HPC helps self-funded employers reduce healthcare costs by identifying and correcting mistakes in medical claims.

Our clients are typically not massive national insurance carriers. They are employers that create and fund their own health plans for their employees. By finding errors, improving claims processes and helping employers better understand where their healthcare dollars are going, HPC helps make healthcare more affordable for the companies and employees we serve. The Opportunity We are looking for a Healthcare Claims EDI Manager who understands more than how to move a file from Point A to Point B. We need someone who understands the entire healthcare EDI and claims data process — how data is received, validated, transformed, transmitted, stored and ultimately used downstream. This person will oversee multiple EDI initiatives and lead our current three-person EDI team while working closely with leadership, internal departments, clients and vendors. The right person will be able to look at a process that is not working correctly, identify where and why the data or workflow is breaking down, and help design a better solution. What You'll Do

• Lead multiple healthcare EDI projects simultaneously from planning through implementation
• Manage and provide direction to HPC's EDI team
• Oversee the receipt, transmission, processing and monitoring of healthcare EDI files
• Work extensively with 837 healthcare claims transactions
• Troubleshoot claims-flow, data-mapping and processing issues
• Identify where data may be lost, changed or incorrectly interpreted between source files and downstream systems
• Help design scalable workflows and processes that meet the needs of different HPC clients
• Develop project plans, timelines and deliverables
• Coordinate with internal teams, vendors and other stakeholders
• Identify risks, solve problems and drive projects through completion
• Perform and oversee QA to ensure claims and EDI processes are functioning correctly
• Communicate project status, technical issues and solutions clearly to both technical and nontechnical audiences
• Help improve documentation, processes and controls as HPC continues to grow What We're Looking For
• 5+ years of healthcare EDI experience
• Strong technical understanding of healthcare claims and EDI operations
• Significant experience with 837P and/or 837I transactions
• Experience troubleshooting healthcare claims-flow and data-processing problems
• Working knowledge of

HIPAA X12

healthcare transactions

• Proven ability to manage multiple projects and competing priorities
• Demonstrated people-management or technical-team leadership experience
• Strong analytical and problem-solving skills
• Strong written and verbal communication skills
• Experience working with technical teams, operations, vendors and business stakeholders
• Proficiency with Microsoft Office, particularly Excel and PowerPoint
• Ability to work effectively in a fast-moving, collaborative environment Even Better If You Have
• Experience with 835, 834, 270/271 and 276/277 transactions
• SQL or database-query experience
• Experience comparing raw EDI source data to downstream system output
• Claims adjudication, payment-integrity or provider-claims experience
• Experience with claims-editing systems or rules
• Project Management experience or PMP certification
• Monday.com or similar project-management tools
• Medical coding certification such as CPC or CCS
• Experience in healthcare cost containment
• Experience building or improving EDI processes rather than simply maintaining an existing environment A Little More About Our Culture HPC takes its work seriously.

We just don't believe that means work has to be boring. Our company band, HPC Rocks, performs at self-funding industry events around the country and has become part of our marketing presence. We also host some pretty unconventional trade-show experiences — including pet-adoption events and, yes, the occasional armadillo race when we're in Texas. Musician, artist or performer? Tell us about it. We enjoy having people on our team who bring interesting talents and experiences outside of their day jobs. HPC is growing quickly, solving meaningful healthcare problems and building something very different in the self-funded healthcare industry. Putting the Fun into Self-Funding.

Job Type:

Full-time Pay:

$80,000.00 - $120,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Paid time off Relocation assistance Tuition reimbursement Vision insurance

Experience:

Healthcare EDI:

5 years (Required)

License/Certification:

Certified Health Claims EDI Specialist Designation (Required)

Work Location:

In person