Full-Time Healthcare EDI and Insurance Discovery Team Lead

The Healthcare Revenue Cycle EDI and Insurance Discovery Team Lead oversees a team of Analysts responsible for Electronic Data Interchange (EDI) operations and healthcare insurance coverage verification. You will report to Experian Health, and ensure the strategic agreement of data exchange with organizational goals, oversees the implementation of scalable solutions, and drive continuous improvement in operational efficiency and compliance and collaborate to support innovation, product development, and revenue cycle optimization.

• Team Leadership & Strategy: Lead, mentor, and develop a team of EDI and insurance discovery analysts. Define team goals, monitor performance, and ensure alignment with departmental objectives. Develop and implement strategic plans for EDI and insurance discovery initiatives. Foster a culture of continuous improvement, innovation, and accountability
• EDI Oversight: Oversee the monitoring, troubleshooting, and optimization of EDI transactions (e.g., 837, 835, 270/271, 276/277). Ensure accurate data exchange with internal systems and external trading partners. Collaborate with IT and vendors to resolve complex EDI issues and implement enhancements. Maintain documentation standards and ensure compliance with industry regulations
• Insurance Discovery Management: Guide the design and execution of insurance verification and discovery processes. Ensure data accuracy and integrity across systems through audits and quality checks. Partner with payers and clearinghouses to resolve escalated coverage issues. Support compliance and regulatory programs related to insurance data
• Collaboration: Serve as the primary liaison between the EDI insurance team and Revenue Cycle, IT, Compliance, and Product. Provide subject matter expertise for new product development and system integrations. Lead training initiatives and knowledge-sharing efforts across the organization

Requirements: Bachelor's degree in Computer Sciences, Healthcare Administration, Information Systems, Business, or related field. 5+ years' experience in healthcare revenue cycle management, with emphasis on EDI, eligibility verification and insurance discovery operations , EDI formats and standards, X12, HL7. 3+ years' experience in a leadership or supervisory role. 5+ years' experience working with HIPAA regulated data, regulation and policy, payer-provider data interchange, and healthcare data standards. 3+ years' experience working with healthcare management systems (e.g., Epic, Cerner) and clearinghouses

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