Western Growers Family of Companies Careers - Director of EDI

Western Growers Health- part of Western Growers Family of Companies- provides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit options provided by Western Growers Health stem from the core mission of Western Growers Association (est. 1926) to support the business interests of employers in the agriculture industry.

Our mission at Western Growers Health is to deliver value to employers by offering robust health plans that meet the needs of a diverse workforce. By working at Western Growers Health, you will join a dedicated team of employees who care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to Western Growers Health today!

Compensation: $ - $ with a rich benefits package that includes profit-sharing. This is a remote position.

JOB DESCRIPTION SUMMARY

The Director of Electronic Data Interchange (EDI) is responsible for overseeing and managing all EDI transactions between Pinnacle TPA, its clients, and vendors. This role ensures the seamless, accurate, and timely exchange of data using the ANSI X12 EDI standard within the healthcare environment. The Director will manage the EDI interface platform, coordinate with internal teams and external partners, and ensure compliance with industry regulations such as HIPAA.

Additionally, the Director will document all EDI-related processes, create operational workflows, and improve departmental efficiency. Serving as the primary contact for all EDI-related inquiries and issues, the Director will ensure that all transactions, configurations, and procedures align with Western Growers Family of Companies (WGFC) overall business objectives. This position reports directly to the Vice President of Information Technology (VP of IT) and requires cross-functional collaboration to align the company's EDI processes with its overall business strategy and compliance requirements.

Qualifications

* BA/BS degree in Information Technology, Computer Science, or a related field ), along with eight (8) to ten (10) years of experience managing EDI operations within a healthcare setting-specifically focusing on eligibility, premium billing, invoicing, and the ANSI X12 EDI standard, preferred.

* Hands-on experience with the EDI interface platforms such as Pilotfish or similar integration tools.

* Strong knowledge of healthcare-related EDI transaction sets (837, 834, 835, 270, 271, etc.).

* Comprehensive expertise in data mapping, EDI standards, and transaction troubleshooting.

* Strong understanding of HIPAA regulations and how they apply to EDI data exchanges.

* Advanced knowledge of healthcare processes, including eligibility verification, claims processing, and payment transactions, is essential.

* Proven ability to document processes, procedures, and workflows in a clear and detailed manner.

* Experience in process improvement and optimizing transaction workflows.

* Strong leadership and project management skills, with the ability to manage cross-functional teams and external vendor relationships.

* Excellent verbal and written communication skills, with the ability to explain complex technical details to non-technical stakeholders.

* Strong skills in troubleshooting, root cause analysis, and implementing effective solutions to EDI-related challenges.

* Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.

* Home router with wired Ethernet (wireless connections and hotspots are not permitted).

* A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)

* A functioning smoke detector, fire extinguisher, and first aid kit on site.

Duties And Responsibilities

EDI Operations

* Oversee and manage the configuration, testing, and execution of all EDI transactions, including 837 (claims), 834 (enrollment), 835 (remittance advice), and 270/271 (eligibility inquiries and responses), among others.

* Ensure smooth, accurate, and timely data exchanges with clients and vendors.

* Maintain a high level of data integrity and compliance with industry standards.

* Develop and maintain complex SQL queries and scripts used to create data marts in Teradata.

* Gather business requirements and prepare analyses based on information from internal and external sources to evaluate and demonstrate program effectiveness and efficiency supporting projects and change requests.

* Design, develop, implement, and maintain Business Intelligence reports using healthcare claims data.

* Develop complex business intelligence solution and supporting data strategy leveraging acquired subject matter expertise to identify opportunities and risks.

* Develop complex dashboards, scorecards, reports, and data analysis using X12/EDI pre-adjudicated data including 835, 277, and 837 transitions.

* Improve the delivery and management of programs by…