Product Owner EDI

Summary

As a Product Owner EDI at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.
 

Your role in our mission

• You will be the Product Owner and the “go to person” for that product.
• Work with diverse teams to work on product changes and enhancements and deliver them on time.
• Be the single owner to work with the PMO/Scrum Master to align ADO workload (from backlog) and prioritize them as required by delivery/contractual timeline.
• Defines and manages the architectural roadmap for one or more platforms, products or services. Provides subject matter expertise in how business capabilities interact with technical capabilities to address client business problems and achieve client goals.
• Provides direction for project and program design activities to ensure that both customer and company business objectives are met. Collaborates and/or partners with business and technical architects to ensure initiatives align with business and information technology improvement strategies.
• Conducts and/or participates in customer's process analysis in order to understand business complexities and constraints and recommends technical improvements. Evaluates existing process and recommends and implements improvements.
• Enables cross-functional teams to work in parallel by providing guidance and direction in support of business solution architecture.
• Supports, resolves, and documents issues that arise in the architecture. Reviews designs and recommends improvements to the architecture. Works with the customer to eliminate gaps and inconsistencies in the business solution architectural design and to ensure that none develop over time.
• Reduces client risk by ensuring that recommended business solutions meet customer's price, scope, and time requirements.
• Uses professional concepts in developing resolution to critical issues and broad design matters.
• Maintains awareness of trends, best practices and standards for the industry and related technology fields. Introduces new technology processes as appropriate.
• Provides leadership and work guidance to less experienced personnel.
• Knowledge of Medicaid program regulations and compliance requirements, including HIPAA, CMS guidelines, CAQH and state-specific Medicaid policies.
• Experience with Medicaid Management Information Systems and their role in claims processing, eligibility verification, and payment systems. 
• In-depth understanding of electronic data interchange (EDI) principles and protocols, specifically as they relate to Medicaid programs.
• Knowledge of Medicaid Enterprise System (MES) architecture and components, including interfaces with external systems and data sources.

What we're looking for

•    Experience with EDI software and tools, such as EDI translators, EDI gateways, and secure file transfer protocols (SFTP, FTPS, AS2)
•    Comprehensive understanding of the EDI process, including data formats, data mapping, data transformation, and data validation
•    Proficiency in Medicaid-specific EDI standards and transactions, such as X12 (including 837, 835, 834, 270/271, 275, 276/277, 278), NCPDP, or other applicable Medicaid EDI standards
•    Understanding of healthcare data privacy and security best practices, including encryption, access controls, audit trails, and data masking
•    Experience with EDI transactions commonly used in healthcare, such as claims, eligibility verification, remittance advice, and prior authorization
•    Familiarity with database systems, data modeling, and SQL queries, and data integration platforms commonly used in MMIS environments

What you should expect in this role

• Opportunities to travel through your work (0-10%)
• Fully remote opportunity with the option to work anywhere within the United States
• The deadline to submit applications for this posting is 4/30/2024.

Note

• Video cameras must be used during all interviews, as well as during the initial week of orientation

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