FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing healthcare EDI products, ensuring compliance with HIPAA and regulatory standards, and driving continuous improvement in transaction processing and integration performance. Proficient in Agile methodologies, product backlog management, and stakeholder communication.
Highest-signal resume keywords
Healthcare EDI ExperienceProduct Owner LeadershipHIPAA X12 Transactions KnowledgeAgile Project ManagementHealthcare Core Administration Platforms
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Healthcare EDIClaims ProcessingEnrollmentProduct Backlog ManagementData AnalysisSQLUser Acceptance TestingKPI MonitoringTransaction Quality ImprovementProcess Flow Development
Soft Skills
Analytical SkillsProblem-Solving SkillsCommunication Skills
Tools & Technologies
QNXTFacetsHealthRulesGuidingCareEDI GatewaysClearinghousesIntegration Platforms
Certifications & Qualifications
Certified Scrum Product OwnerAgile Certification
Industry Keywords
HIPAA ComplianceMedicare OperationsMedicaid OperationsCommercial Health PlansHealthcare Data Exchange Standards
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Define and communicate the vision, roadmap, and priorities for healthcare EDI products and services
- Own and prioritize the EDI product backlog, including features, enhancements, defects, and technical debt
- Align EDI initiatives with organizational objectives
- Evaluate industry trends, regulatory changes, and emerging technologies
- Gather requirements and define solutions with business operations, claims, enrollment, provider services, finance, compliance, and IT teams
- Serve as the primary point of contact for EDI product decisions and issue resolution
- Facilitate communication with internal stakeholders, external trading partners, vendors, and clearinghouses
- Develop business requirements, user stories, acceptance criteria, and process flows
- Lead backlog grooming, sprint planning, and product demonstrations in Agile environments
- Ensure solutions meet business, quality, and regulatory requirements
- Support User Acceptance Testing and production implementation
- Oversee EDI transaction processing and integration performance
- Monitor and improve transaction quality, accuracy, and timeliness
- Support implementation and maintenance of healthcare transaction sets, including claims, remittance, eligibility, claim status, prior authorization, enrollment, and NCPDP pharmacy transactions
- Coordinate onboarding and testing of new trading partners
- Ensure compliance with HIPAA, CMS, state regulations, and organizational standards
- Support regulatory initiatives and remediation efforts with compliance and audit teams
- Maintain documentation, process standards, and governance controls
- Define and monitor KPIs for EDI operations and product performance
- Analyze transaction trends, error rates, and operational metrics
- Drive continuous improvement to increase automation, efficiency, and customer satisfaction
Requirements
What you’ll need- Bachelor's degree in Business, Healthcare Administration, Information Systems, Computer Science, or related field; equivalent experience may be considered
- 5+ years of healthcare EDI, claims processing, enrollment, or healthcare systems experience
- 3+ years of Product Owner, Product Manager, Business Analyst, or equivalent leadership experience
- Strong knowledge of HIPAA X12 transactions and healthcare data exchange standards
- Experience working with healthcare payer, provider, TPA, or managed care organizations
- Experience managing Agile projects and product backlogs
- Strong analytical, problem-solving, and communication skills
- Experience with healthcare core administration platforms such as QNXT, Facets, HealthRules, or GuidingCare
- Certified Scrum Product Owner (CSPO) or Agile certification
- Knowledge of Medicare, Medicaid, and Commercial health plan operations
- Experience with EDI gateways, clearinghouses, and integration platforms
- Familiarity with SQL, data analysis, and reporting tools
Benefits
Comp & perks- Multiple health and dental plans with nationally recognized networks
- Vision benefits
- Total wellness program
- Employee assistance program for employees and families
- Competitive wages
- Retirement savings plans
- Company-paid disability and life insurance
- Pre-tax savings opportunities (HSA and/or FSA)
- Professional development offerings
- Opportunities for remote work
- Generous paid-time-off program
- Flexible scheduling for vacations, illness, life events, and unexpected circumstances