Head of EDI Operations & Healthcare Data Exchange

Louisiana Blue; Baton Rouge (LA); On-site; USD 120,000 - 160,000; Full time

Job summary

Louisiana Blue is seeking an experienced leader to head the EDI Customer Operations team, directing provider connectivity solutions, clearinghouse operations, and provider-facing digital platforms. You will oversee daily transaction processing, systems support, incident resolution, testing, and project execution to ensure secure exchange of healthcare information.

You will drive performance through metrics, budgeting, vendor management, and cross-functional collaboration with technology

Qualifications

• Bachelor’s degree in a related field; four years of directly related experience may substitute.
• 5 years of experience in healthcare operations, EDI, provider connectivity, systems operations, healthcare technology, or a related field.
• 2 years of leadership experience.
• Advanced knowledge of HIPAA Transactions and Code Sets, healthcare EDI standards, and electronic healthcare transaction processing.
• Strong understanding of healthcare claims, clearinghouse operations, provider connectivity, and related business processes.
• Demonstrated ability to lead operational, technology, and process improvement initiatives, including project delivery, change management, automation, and continuous improvement efforts.
• Proven analytical, critical-thinking, and problem-solving skills, including the ability to diagnose complex business and technical issues and implement effective solutions.
• Strong leadership, communication, organizational, and interpersonal skills, with the ability to build partnerships, influence stakeholders, and lead cross-functional teams.
• Ability to interpret technical documentation, operational metrics, and business requirements to drive informed decision-making and operational excellence.
• Commitment to

Responsibilities

• Provides leadership, direction, and development for staff responsible for EDI operations, provider connectivity, systems support, implementation activities, and customer support services.
• Oversees the organization’s electronic transaction ecosystem and provider-facing digital services, ensuring system reliability and the accurate, timely, secure, and compliant exchange of healthcare transactions and information.
• Ensures compliance with applicable HIPAA, CMS, Blue Cross and Blue Shield Association, state, federal, and other regulatory requirements governing electronic transactions, provider connectivity, data exchange, and related operational processes.
• Leads operational support, incident management, root-cause analysis, process improvement, automation, and technology enhancement initiatives to improve efficiency, scalability, accuracy, service delivery, and customer satisfaction.
• Monitors operational performance through metrics, reporting, forecasting, and trend analysis. Manages strategic planning, budgeting, resource allocation, vendor relationships, and operational priorities to support current and future business needs.
• Partners with leaders, business areas, technology teams, healthcare providers, clearinghouses, vendors, government agencies, regulatory bodies, and other external parties to establish priorities, resolve issues, coordinate system enhancements, and implement enterprise projects and regulatory changes.

Skills

EDI operations

Leadership

Healthcare compliance

Data analysis

Project delivery

Vendor management

Education

Bachelor’s degree in Computer Science, Information Systems, Business Administration, or Healthcare Administration

Tools

HIPAA Transactions

Job description

Louisiana Blue is seeking an experienced leader to head the EDI Customer Operations team, directing provider connectivity solutions, clearinghouse operations, and provider-facing digital platforms. You will oversee daily transaction processing, systems support, incident resolution, testing, and project execution to ensure secure exchange of healthcare information.

You will drive performance through metrics, budgeting, vendor management, and cross-functional collaboration with technology