Director of Electronic Data Interchange (EDI) and Business Intelligence

Director of Electronic Data Interchange (EDI) and Business Intelligence

Overview

The Director of EDI works with internal teams to provide cutting edge solutions that directly improve the healthcare industry.  The Director leverages software and services to transform data into actionable intelligence supporting decision making.  This intelligence helps Child and Family Guidance Center Officers to gain insights into the operations improve process efficiency and create a competitive market advantage.  The Director of EDI is responsible for evaluating design, development, and coordination of EDI projects, applications, and business intelligence solutions.  The Director of EDI works closely with developers, operations staff, and IT management ensuring proper design principles and coding techniques are within the industry standards.  The Director of EDI crafts and executes queries upon request for data, presenting information through reports and visualizations.  The Director of EDI gathers business and operational analysis related to EDI applications, and develops processes.

Responsibilities

• Oversee migration from existing Electronic Health Record (EHR) to NetSmart
• Translate business needs to technical specifications – design, build, and deploy business intelligence solutions (e.g. reporting tools)
• Analyze needs, develop changes and enhancements, and maintain the Electronic Medical Record based on organizational requirements
• Designs, codes, tests, and implements federal/state mandated electronic transactions and other applications
• Designs, develops, and supports HIPAA compliant transactions and other application development projects as required, using appropriate tools and technologies such as Sybase’s Ec Map, Ec Gateway, Active Batch, SQL Server, Oracle, .NET, and Java.
• Manages the design, testing, and implementation methodologies, ensuring proper design principles and coding techniques are within the industry standards.
• Oversees the day-to-day EDI operations, and assists in troubleshooting.
• Oversees planning and ensures resources are appropriate and available to support the EDI operations and development activities.
• Performs requirements gathering, business and operational analysis, and works closely with IT management and other department staff.
• Manages the testing of EDI transactions with stakeholders and other certification authorities as mandated by the state and federal regulations.
• Manages the identification and development process to securely transfer EDI and HIPAA compliant transactions between CFGC and stakeholders.
• Maintains in-depth knowledge of CMS regulations, HIPAA, technical specifications and the current HIPAA EDI rules from both technical and user perspectives.
• Develops policies and procedures to document EDI operations
• Participates in negotiation of CFGC agreements and provides assistance to providers in preparing HIPAA compliant transactions for CFGC.
• Creates and maintains documentation for all EDI projects and participates in team meetings, conferences, and problem solving discussions.
• Manages and motivates EDI development and operations staff members while maintaining cultural awareness/sensitivity.
• Actively participates and contributes to the strategic direction of long-term EDI technology roadmap, and designs new solutions to solve problems facing the organization.
• Maintains functionality of hardware, software, and networking to support EDI functions.
• Keeps abreast of new technologies and recommends those that would enhance staff and the use of technology to perform EDI functions more effectively.
• Performs other assigned or needed activities required to assure success of the EDI development role and to support other work of the IT Department.

Qualifications, Education, and Experience

• Behavioral health/healthcare experience preferred – previous experience with CCBHCs and/or FQHCs a plus
• Experience transitioning from one EHR to another
• Bachelor’s or Master’s degree in Computer Science, Business, or a related field preferred.
• SSIS and Power BI needed with experience with Microsoft Power BI
• At least five (5) years of lead or management experience in Information Systems with a focus on EDI development in MS SQL Server and Oracle environment.
• Minimum five (5) years of experience in health care.
• Basic knowledge of CPT, Healthcare Common Procedure Coding System (HCPCS), and ICD- 9-CMcoding is preferred. • General understanding of the medical billing process is preferred.
• Demonstrated experience with large, highly complex projects.
• Substantial experience with EDI and knowledge of translators such as Sybase Ec Map and Database Development with Oracle 10/11g, SQL Server 2005 and/or 2008 is required.
• Experience with Sun’s Java and Microsoft’s .NET technologies such as VB.NET, ASP.NET, ADO.NET is preferred.
• Knowledge of scheduling systems is a plus.
• Advanced knowledge in Microsoft Word, Excel, Access, Outlook, and the like
• Certification in either the Microsoft or Oracle platform is plus.
• Knowledge of health care coding systems.
• Ability to quickly acquire in-depth knowledge of software and managed care issues.
• Strong written and oral communication skills with ability to interpret and understand technical requirements.
• Strong organizational skills
• Excellent analytical skills to troubleshoot and resolve systems problems.
• Attention to detail.