Define and evolve the EDI product vision, strategy, and long-term roadmap in alignment with enterprise architecture, regulatory mandates, and CareSource’s operational priorities.
Create business cases, success metrics, and ROI analyses to guide prioritization and investment decisions.
Stay current on industry trends, CMS/state requirements, and interoperability standards (X12, APIs, FHIR) to shape the future-state EDI landscape.
Translate complex business, regulatory, and integration requirements into clear, actionable user stories and technical specifications for engineering teams.
Ensuring requirements encompass data mapping, validation business rules, error handling flows, and integration points across downstream systems.
Collaborate closely with architecture, engineering, QA, and DevOps to guide solution design, ensure technical feasibility, and support high-quality deployment.
Own and prioritize the EDI product backlog based on technical dependencies, stakeholder value, operational impact, and compliance needs.
Drive sprint planning, feature readiness, and release coordination to support predictable and transparent delivery.
Identify and remove impediments that impact engineering throughput or trading partner readiness.
Act as a bridge between technical teams, trading partners, clearing houses, and internal business units to ensure alignment and clarity of expectations.
Lead discovery sessions, refinement cycles, data exchange walkthroughs, and post-implementation assessments.
Advocate for partner usability and operational efficiency through system improvements, automation, and enhanced monitoring capabilities.
Analyze transaction performance, defect trends, operational SLAs, and platform telemetry to identify risks, bottlenecks, and optimization opportunities.
Define and track KPIs/OKRs such as transaction throughput, first-pass acceptance rate, error volume, partner onboarding speed, and system reliability.
Collaborate with engineering to drive continuous improvement in observability, error reconciliation, and data integrity.
Establish and maintain comprehensive product documentation, functional requirements, user guides, and integration specifications.
Contribute to technical standards, EDI governance frameworks, and best practices for onboarding, testing, and release coordination.
Ensure solutions comply with HIPAA, state Medicaid requirements, data privacy standards, and CareSource security guidelines.
Perform any other job related duties as requested.
Strong understanding of EDI technologies and integration platforms
Familiarity with Agile methodologies and product development life cycles
Skilled in software development or engineering
Understanding of the Healthcare industry and ecosystem including future direction. In-depth knowledge of interoperability standards relevant to the industry
Strong verbal and written communication skills are essential for articulating product vision and collaborating with stakeholders
Strong analytical and problem-solving skills to assess performance and identify areas for improvement
Ability to adapt to rapidly changing technologies and market conditions
A mindset geared toward innovation, continuously seeking new ways to enhance capabilities and interoperability
Knowledge of AI technologies, machine learning models, and ethical considerations in AI deployment
