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As the Lead EDI Analyst reporting to the Manager of EDI, you will be able to leverage your well-developed technical skills while simultaneously developing and refining your people leadership skills. You will be responsible for ensuring the effective and efficient processing of EDI transactions, providing documentation support of various EDI files, performing quality assurance data analysis, and acting as a liaison between SFHP and external data partners, including State and other contractual/regulatory agencies.

Hiring priority will be given to applicants that reside in the San Francisco Bay Area or California.

WHAT YOU'LL DO

• EDI Operations Management:

o Lead and oversee the day-to-day operations of the EDI team, ensuring efficient and timely handling of electronic transactions.

o Monitor and manage the EDI system’s performance, identifying and resolving any issues or bottlenecks that may arise.

o Collaborate with cross-functional teams to develop and implement EDI strategies, standards, and best practices.

• EDI Development and Integration:

o Analyze business requirements and work closely with internal stakeholders to design and implement EDI solutions that align with organizational goals.

o Develop, configure, and test EDI maps, scripts, and workflows to enable seamless data exchange between internal systems and external trading partners.

o Coordinate and lead trading partner onboarding activities, including testing and certification processes.

• Compliance and Quality Assurance:

o Ensure compliance with industry-specific EDI standards, such as ANSI x12, or industry-specific formats (e.g., HIPAA, ASC X12N, HL7, FHIR HL7).

o Perform regular audits and quality checks to validate the accuracy and integrity of EDI transactions and resolve any data discrepancies.

o Stay updated on industry trends, emerging technologies, and regulatory changes related to EDI, and proactively recommend process improvements.

WHAT YOU'LL BRING

• Bachelor’s degree or higher or relevant industry experience
• Proven experience as an EDI analyst, with a minimum of 5-7 years in a senior, lead or supervisory capacity.
• 5-7 years of experience in analysis of healthcare data (pharmacy, encounter, providers, and membership), including knowledge of relevant code sets (diagnosis, procedure, revenue codes).
• 5-7 years of experience using Edifecs products (Smart Trading, Transaction Management, Spec Builders, Xengine).
• 5-7 years of data analysis.
• PC literacy and demonstrated experience with MS Office (Outlook, Word, Excel, PowerPoint).
• In-depth knowledge of HIPAA/EDI X12 5010 healthcare-related file formats including 278, 834, 835, 837, 999, 277, 820, NCPDP, HL7, FHIR HL7 formats.
• Ability to synthesize data from various sources and perform various types of data analysis.
• Advanced proficiency using SQL programming language and MS Excel.
• Familiarity with industry standard health data code sets such as ICD-9/ICD-10, CPT/HCPCS, revenue codes, and NDC (Pharmacy).
• Knowledge of Cognizant products.
• Strong communication and interpersonal skills to effectively collaborate with internal teams, external partners, and stakeholders.
• Detail-oriented with a focus on quality assurance and data integrity.
• Understanding HIE/Interoperability concepts.

WHAT WE OFFER

A competitive and robust compensation package, including:

• Health benefits – several plan choices to cover you and your dependents medical, dental, vision needs
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays
• An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!
• The chance to make a difference in the lives of many San Francisco residents!

ABOUT US

Established in 1997, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.