Mgr., Electronic Data Interchange & Interoperability - PCHP

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Responsible for the analysis of application solution requirements as well as implementation and support of the clinical and business applications utilized across Parkland Community Health Plan (PCHP), including maintenance of application workflow configurations.

Minimum Specifications

Education

• Associate degree in information systems, computer science, healthcare, or related discipline required. Bachelor’s degree preferred.

Experience

Required

• Four (4) years of progressive experience implementing and supporting Electronic Data Interchange (EDI) processes in a managed-care environment, including the exchange of eligibility, authorization, claims, and other X12 transactional workflows required.

Preferred

• Two (2) years of experience utilizing Managed-file Transfer solutions that adhere to industry best-practice approaches under strict regulatory control. Specific experience with Progress’ MOVEit preferred.
• Two (2) years of experience managing complex IT projects that require engagement of both technical and business resources and working with technology vendors.
• Experience utilizing / supporting Cognizant QNXT and Care Advance solutions in a managed-care organization preferred.
• Experience supporting an Identity Management Solution such as Okta is preferred.

Skills or Special Abilities

• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.
• Strong interpersonal skills with the ability to establish and maintain effective working relationships across and beyond the organization.
• Demonstrated ability to present documented requirements and proposed solutions to both technical and business audiences.
• Ability to manage multiple, competing projects and deadlines as well as respond to rapidly changing priorities.
• Extensive knowledge surrounding the business processing requirements between healthcare entities, including Provider Organizations, Managed-Care Organizations, TPAs, Clearinghouses, and HIEs, and specifically covering the full-scope of X12 transactions commonly used in healthcare administration and care delivery.
• Able to assess and evaluate necessary system controls, interacting directly with clearinghouses, state agencies, and other trading partners to appropriately test and troubleshoot EDI processes.
• Working knowledge surrounding the evolving interoperability standards and capabilities in support of data exchanges between Payers-Members, Payers-Providers, and Payers-Payers, including familiarity with specific regulatory mandates that are driving these technology solutions forward, such as CMS’ Patient Access final rule and Prior Authorization proposed rule.
• Familiarity with the specific technology standards and tools driving adoption of healthcare interoperability, including TEFCA, FHIR, and SMART.
• Extensive knowledge of HIPAA Security and Privacy requirements and how they are implemented across EDI and Interoperability systems operations.
• Skilled problem solver who is able to troubleshoot complex issues, identify root cause, and analyze opportunities to implement preventive measures to avoid recurrences.
• Excellent time management and organizational skills.
• Strong knowledge of Project Management principles and methodologies.

Responsibilities

Operations

• Works with stakeholders across organization to clearly define IT solution requirements and assists in the selection and / or design of new or modified applications across the PCHP operating environment.
• Documents and presents proposed IT solutions, gathering input and refining final project proposals.
• Applies specific healthcare interoperability requirements and standards in the ongoing evaluation of proposed or modified solutions, ensuring ongoing compliance with regulatory mandates.
• Supports the design and operation of data interfaces between PCHP and its trading partners/vendors.
• Provides ongoing implementation and support services across adopted applications, including design and configuration, testing, training, monitoring, and end-user support.
• Works with assigned Project Managers to define and fulfill specific implementation steps relating to design, configuration, testing, and training of new solutions.
• Collaborates with Parkland Health IT and other business partners / vendors to ensure cross-system effectiveness and thorough investigation of reported issues.
• Partners with vendor technical support teams, data integration teams and other technical teams working collaboratively to assess and resolve issues.
• Assist with RFP preparation, review, and solution selection activities as requested.

Fiscal Management

• Operational responsibility for the financial performance of assigned area(s).
• Promote activities to achieve operational efficiency.
• Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets.
• Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs.
• Manage staffing levels within established targets.

Talent Management

• Recruits and retains a diverse, quality workforce.
• Accountable for orientation, ongoing education and training, and competency verification for all employees.
• Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets.
• Timely completion of employee performance appraisals.
• Promote and foster a diverse, inclusive, highly engaged, and collaborative work environment within areas of responsibility. Utilize workforce metrics to monitor, identify, and respond to workforce trends.
• Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan.
• Mentor, coach, and support direct reports with building teamwork, professional development, and education to achieve optimal performance and develop talent.
• Ensure employee engagement survey participation rates and results meet established targets.
• Mandatory requirements are complete and required credentials are current and in good standing.
• Employee performance is monitored and managed. Consults with the Office of Talent Management as appropriate regarding disciplinary action.

Professional Accountability

• Must act with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adhere to organizational policies, procedures, and guidelines.
• Complete assigned training and annual health requirements timely.
• Recognize and communicate ethical and legal concerns through the established channels of communication.
• Demonstrate accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintain confidentiality at all times.
• Perform other work as requested that is reasonably related to the employee’s position, qualifications, and competencies.

Job Accountabilities

1. Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP.
6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.