Company Overview:

Our company is a start-up that specializes in episodes of care benefit plans. We have a deep expertise in episode pricing and analytics and our goal is to bring transparency and efficiency to the healthcare market. Our company is committed to providing high-quality, affordable healthcare to our customers.

Role Summary:

The Data Integration Manager for Healthcare Transactions is responsible for overseeing the integration of healthcare data—including claims and other transactions—into the organization’s systems. This role ensures data quality, compliance, and operational efficiency, while also maintaining strong relationships with internal teams, clients, and vendors. The ideal candidate combines technical expertise in data integration with a client-focused approach and deep knowledge of healthcare data standards.

Responsibilities:

• Develop and maintain a strategic plan for integrating healthcare data (claims, enrollment, etc.) into organizational systems, aligning with business needs, compliance requirements, and technological capabilities.
• Ensure all data transactions comply with relevant standards (e.g., HIPAA, HITECH), monitoring for regulatory updates and implementing necessary changes.
• Coordinate with IT, Operations, and other teams to integrate data into billing and other core systems, including the development and management of interfaces or APIs.
• Lead data mapping and transformation activities, working with analysts and developers to validate, normalize, enrich, and ensure compatibility with internal data models.
• Implement robust error handling and monitoring processes to guarantee the accuracy and reliability of integrated data, swiftly resolving issues such as formatting errors or missing information.
• Optimize integration processes for performance and efficiency, considering data volume, processing speed, and system resource utilization.
• Collaborate with infrastructure and security teams to implement security measures (encryption, access controls, audit trails) that protect sensitive healthcare data and ensure regulatory compliance.
• Communicate effectively with internal stakeholders (IT, Operations, Security, Compliance) and external partners to align integration efforts with organizational objectives.
• Manage relationships with third-party vendors, ensuring service level agreements (SLAs) are met and vendor solutions support integration needs.
• Continuously evaluate and improve integration processes, technologies, and workflows to enhance efficiency, accuracy, and performance.
• Serve as a liaison between the organization and its clients (e.g., insurance companies, healthcare providers), understanding their requirements, preferences, and expectations for data transactions.
• Collaborate with account management teams to gather client requirements, translate them into technical specifications, and ensure integration processes meet client needs (e.g., custom 837 claims, 834 enrollment files).
• Facilitate client onboarding, ensuring smooth integration of transactions, and provide training and support as needed.
• Proactively communicate with clients regarding integration project status, upcoming changes, and issue resolution to maintain strong relationships and high satisfaction.
• Identify opportunities for account growth and retention by expanding services based on client needs and industry trends.
• Solicit and incorporate client feedback to drive continuous improvement of integration workflows, tools, and services.

Qualifications:

• Bachelor’s degree in Computer Science, Information Systems, Healthcare Informatics, or a
• related field (Master’s preferred).
• 5+ years of experience in data integration, preferably within the healthcare sector.
• Strong knowledge of healthcare data standards (e.g., HIPAA, HITECH, X12, HL7).
• Experience with system integration, data mapping, ETL processes, and API development.
• Familiarity with healthcare claims (837), enrollment files (834), and related transaction sets.
• Proven ability to manage cross-functional teams and vendor relationships.
• Excellent communication, analytical, and problem-solving skills.
• Experience in client-facing roles and a demonstrated commitment to client satisfaction.