About HealthEdge 
HealthEdge® is trusted to provide the technology and services that power health plans’ most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next-gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences. For more information, visit www.HealthEdge.com.

Position Overview:

We are searching for a highly skilled and experienced Healthcare EDI & Client Engagement Manager to join our growing team. In this role, you will oversee HIPAA EDI transactions, client communications, and cross-functional coordination. This role is responsible for ensuring seamless electronic data interchange (EDI) transactions, maintaining compliance with HIPAA regulations, and managing client relationships. The ideal candidate will act as a bridge between internal teams, partners, and customers, ensuring high-quality service delivery, application of standard practices across board, prompt issue resolution, and operational excellence in EDI processes. 

Your Impact:

Key Responsibilities:

• Act as a liaison between account teams, partners, and customer
• Act as an Inhouse HIPAA EDI transactions SME
• Support technology and business operations on EDI and clearinghouse
• Support Implementation and Sales teams as needed

EDI & Compliance Management:

• Monitor and manage HIPAA-compliant EDI transactions (837, 835, 270/271, 276/277, 278, 820, etc.).
• Ensure timely processing and resolution of EDI-related issues, including data integrity, rejections, and errors.
• Collaborate with IT, Compliance, and Operations teams to troubleshoot, optimize, and enhance EDI workflows.
• Maintain up-to-date knowledge of HIPAA, X12 standards, and payor regulations.
• Conduct gap analysis to ensure EDI compliance and data accuracy.

Stakeholder Management (Partner and Clients):

• Serve as the primary point of contact for clients and EDI partner regarding EDI, clearinghouse processes, transactions, and issue resolution.
• Establish and maintain strong partner relationship, proactively addressing concerns and expectations.
• Coordinate cross-functional teams (IT, Claims, Finance, Provider Services) to resolve client-reported issues efficiently.
• Lead client meetings, status updates, and performance reviews to ensure alignment and satisfaction.
• Provide training and guidance to internal teams and clients on EDI processes and industry changes.

Operational & Performance Oversight:

• Report EDI transaction success rates, rejections, and turnaround times.
• Define and manage KPIs such as first-pass claim acceptance rate, EDI rejection rate, and processing time.
• Work closely with internal teams to streamline workflows and implement best practices for EDI optimization.
• Ensure that service-level agreements (SLAs) are met for all EDI transactions and client expectations.
• Identify opportunities for process improvements and automation to enhance efficiency.

This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.

What You Bring:

• Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field.
• 5+ years of experience in healthcare EDI transactions, client management, or payer operations.
• Experience in healthcare claims processing, eligibility verification, and remittance advice transactions.
• Strong understanding of HIPAA 5010, ANSI X12, and other EDI transaction sets (837, 835, 270/271, etc.).
• Strong knowledge of CMS, Medicaid, Medicare, and commercial payor regulations.
• Proficiency in EDI tools, SQL, data mapping, and reporting.
• Proven ability to manage client expectations, drive issue resolution, and lead cross-functional coordination.
• Excellent communication, negotiation, and stakeholder management skills.

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers.

Geographic Responsibility: While HealthEdge is located in Boston, MA you may live anywhere in the US
Type of Employment: Full-time, permanent

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

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**The annual US base salary range for this position is $140,000 to $160,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.