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Job Description: The Medicaid EDI Manager will play a critical role within the Business Data Solutions team to maintain and implement Medicaid encounter feeds. The Medicaid Manager will be the primary resource implementing new client and/or state outbound transactions. The Manager will develop requirements based on stakeholder meetings and interpretation of Companion Guides. The Manager will identify, recommend and implement process improvements in support of the EDI system based on observation, monitoring and external inquiries regarding EDI issues.
Secondary responsibilities include researching and analyzing encounter edits or rejections for Medicaid clients and work with internal/external teams to resolve. The Manager will work to improve overall encounter, member and provider data quality. As well they will track encounter submission quality and timeliness.
There will actually be 5 courses that required for all temporary employees:
3 for Compliance purposes and 2 for HiTrust / Security requirements:
1. General Compliance
2. HIPAA
3. Fraud, Waste, and Abuse
4. Security Essentials
5. Introduction to Phishing
In addition; Model of Care, ODAG, FSL Fraud Integral Staff training, CA Fair Claims.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Date Posted: 12 April 2025
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