The Consultant, Interoperability, EDI & Product Management, Provider Connectivity Solutions role applies their discipline-specific knowledge of Electronic Data Interchange (EDI), X12 & HL7 standards and CMS/ONC Regulatory Compliance or institutional knowledge and skills in the performance of departmental activities which support the operations of the Company. The Consultant, Interop EDI&Prod Mgnt PCS is a seasoned, subject matter experts who apply specialized knowledge, typically as individual contributors, in primarily assisting senior and executive management in matters that require expertise and experience. Incumbents may directly manage a small number of employees (two or less); the primary function of the role is consulting. This role requires direct experience working with clinicians and office-staff within a practice and/or health system in addition to working with health technology vendors. This role contributes directly to the success of our Provider Experience, Clinical and Workflow operations, HEDIS/Quality ratings, and the Provider Network Solutions scorecard. Provides objective consultation to the Director and Senior Director of Provider Connectivity Solutions and the VP of Strategic Partnerships in the execution of the Provider Connectivity Solutions strategy.
What Are Your Key Responsibilities
Understand strategic direction of the business unit and organization and provide guidance to senior management based on subject matter expertise.
Represent as the business lead for high-profile, high-risk, multi-million-dollar program initiatives such as; Provider Interoperability (~$6M), CMS/ONC Interoperability APIs (~$9M), Availity Strategic Initiatives (~$1M), WebTPA, BlueCard Modernization (~$1.5M), Harmony & others
Author and contribute to Industry whitepapers and/or participate in panels or speaking engagements specific to; Interoperability, Electronic Data Interchange (EDI) or Product Management specific to the Provider Connectivity Solutions strategy. - Advise senior management on options, opportunities, risks, solutions, cost versus benefits and impacts on business processes, systems, employees, etc. Influence and gain acceptance of ideas and suggestions.
Maintain frequent contact with internal and external business partners to obtain and share information for influencing decisions, selling concepts, and/or providing advice and counsel that impacts business decisions and objectives.
Lead the design and development of complex tools, systems, processes, programs, etc. that directly impact business decisions and objectives.
Serves as subject matter expert and mentor others.
This role contributes directly to the success of our Provider Experience, Clinical and Workflow operations, HEDIS/Quality ratings, and the Provider Network Solutions scorecard.
Provides objective consultation to the Director and Senior Director of Provider Connectivity Solutions and the VP of Strategic Partnerships in the execution of the Provider Connectivity Solutions strategy.
What We Require
6+ years related work experience. Experience Details: working experience with technology vendors specialized in Interoperability and/or Electronic Data Change and/or Data ingestion/presentation such EMR vendors & Integrators (e.g., Athena Health, Epic, MediVu, VIM), Provider Engagement Platforms and API channels (e.g., Availity, Change Healthcare)
Related Bachelor’s degree or additional related equivalent work experience
5+ years working experience with technology vendors specialized in Interoperability and/or Electronic Data Change and/or Data ingestion/presentation such EMR vendors & Integrators (e.g., Athena Health, Epic, MediVu, VIM), Provider Engagement Platforms and API channels (e.g., Availity, Change Healthcare)
In-depth understanding of health care business operations and management - Strong project team leadership and consensus building skills, with a willingness to continually embrace personal and professional development
Experience leading project teams
Well-developed problem-solving skills and solutions development
Experience with IT development processes and methodologies
Experience designing and implementing business processes, controls, and performance measures
Demonstrated ability to work with staff and management at all levels of the company
Thorough knowledge of Information Technology fields and computer systems
Experience with Product Management
Product Discovery, Planning & Development
Thorough knowledge and experience of systems, subsystems, development methodologies, systems architecture, tools, and processes that support the assigned business initiative or system
What Is Preferred
Licenses and Certifications: Active LPN, RN, PA, PhD license
3+ years working as a clinician within a practice and/or health systems
3+ years membership experience with one or more of the following:
ANA (American Nurses Association),
CHIME (College of Healthcare Information Management Executives),
AHIMA (American Health Information Management Association),
AMIA (American Medical Informatics Association)
Working experience with technology vendors specialized in Interoperability and/or Electronic Data Change and/or Data ingestion/presentation such EMR vendors & Integrators (e.g., Athena Health, Epic, MediVu, VIM), Provider Engagement Platforms and API channels (e.g., Availity, Change Healthcare)
General Physical Demands
Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally
What We Offer
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
Medical, dental, vision, life and global travel health insurance;
Income protection benefits: life insurance, Short- and long-term disability programs;
Leave programs to support personal circumstances;
Retirement Savings Plan includes employer contribution and employer match;
Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days
Additional voluntary benefits available; and
A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.
About Us
At GuideWell, we are committed to making diversity, equity and inclusion part of everything we do. We believe in hiring people who represent the communities we serve while creating a workplace that encourages a sense of belonging for everyone, no matter who you are or where you come from.
From students to former military to seasoned professionals, our family of mission-based companies are stronger because of the unique talents and skills of our employees. We believe everyone’s contribution has the power to help people and communities achieve better health. Find your new team today.
About The Team
Florida Blue, A GuideWell Company, has been providing health insurance to residents of Florida for 75 years. Driven by its mission of helping people and communicating to achieve better health, the company serves more than five million health care members across the state. We are looking for exceptional people who will bring our mission to life and succeed by putting the members first.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Information Technology
Industries
Insurance
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