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Experian Director, Payer Relationship and Connectivity Strategy in Costa Mesa, California

At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

Job Summary:

The Director - Payer Relationship and Connectivity will be responsible for coordinating internally and externally the implementation of new payers through both direct connections and clearinghouse partnerships for all electronic and related transactions. This position is also the escalation path for all existing payer and trading partner connectivity. In addition, this key position provides guidance and best practice expertise to product managers and technical teams, while also representing Experian Health’s interests with industry partners and trade associations.

Job Duties:

  1. Execute Payer connectivity strategy as defined by EH Clearinghouse and product needs.
  2. Drive and facilitate, in collaboration with EH legal team, contracting with payers, trading partners, and third parties to ensure EH has appropriate legal standing/protection to transact data on behalf of our customers and business interests.
  3. Keep Payer contact list current and available for EH.
  4. Serve as the external liaison on behalf of EH with Payer connectivity/EDI business leaders and technical teams to ensure EH is aligned on availability, innovative connectivity options, and issue resolution (for traditional EDI and innovative new methods/transaction types).
  5. Document payer connectivity and transaction requirements and validation edits, ensuring EH teams have access to the latest information on Payer connectivity including payer edits and payer enrollment requirements.
  6. Internal escalation path for payer related issues: Facilitate efficient and quick connectivity issue resolution through direct engagement with EH internal teams, Payer, Provider, and/or trading partner resources. (including payer enrollment escalations).
  7. Facilitate EH engagement and involvement with industry trade associations (WEDI, X12, HL7, CAQH CORE, etc.)
  8. Create and maintain internal and external Payer list

    Other Duties as Required.

Knowledge & Skills: * * • X12 transaction knowledge with a focus on: • 837 • 835 • 276/277 • 270/271 • 278 • Payer/Provider Enrollment process • Payer EDI process • API methods • Experience writing and reviewing business, technical, and user non-functional/system level requirements

Education & Experience:

• Bachelor’s degree in Business, Computer Science, or related field preferred. • 7-10 years Health EDI experience • At least 10 years prior connectivity, business analyst, or implementation experience in healthcare revenue cycle management software and technology (Health System, Payer, or Vendor) • Direct people manager/supervisory experience highly preferred Equivalent combination of education and experience may be considered.

Special Skills and Knowledge:

• Healthcare revenue cycle experience required • Understanding of HL7 and X12 message/file formats and transactions • Effective communication and relationship building skills • Strong organizational skills, with ability to prioritize and execute tasks. • Experience working in a team-oriented, collaborative environment • Flexible, able to respond quickly to changes in project scope or timescales. • Self-driven and highly motivated to be a high performing trusted resource within the organization. • Proficient with tracking and managing multiple projects working with a variety of cross-functional resources (multi-tasking and prioritizing skills). • Self-motivated, autonomous

Licenses, Certifications, etc.: WEDI, X12, HL7, CAQH CORE

/Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies./ /EOE including Disability/Veterans/

Job: *Product Management

Organization: *Health

Title: Director, Payer Relationship and Connectivity Strategy

Location: United States

Requisition ID: 197599

Other Locations: United States-Illinois-Schaumburg, United States-Tennessee-Franklin, United States-Texas-Austin, United States-Georgia-Atlanta, United States-California-Costa Mesa

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