The Enterprise Shared Services Program Manager II is responsible for leading and managing a portfolio of strategic and transformational enterprise wide programs and projects that are generally complex and large in scope. In this capacity, the Program Manager works collaboratively with leadership, management and other stakeholders including Business Owner(s), Investment Review Board, intake and program/project teams and participates in program governance and administration meetings as appropriate.

• Leads all system upgrades, enhancements, and new deployments for Enterprise Shares Services and is a subject matter expert in EDI and Claims transactions.
• Works collaboratively with Information Technology leadership (Architecture, Solutions Delivery, Technical Delivery, etc.) to prioritize, evaluate, and deploy solutions which contribute to the accurate receipt, loading, and exchange of claims data managed by the Claims Data & Support Services teams.
• Functions as the Lead Technical expert in Enterprise Shared Service, leading a team or multiple teams and performs liaison activities with leadership, management, and other stakeholders.

• Extensive knowledge and experience working on EDI transactions – 827, 835, RA, 277CA, 834, and 278
• Experience and knowledge working with FHIR standards on Patient Access API, Provider Directory API, Payer to Payer API, Pre Authorization API
• Experience working on: Claims – Intake, adjudication, premium billing, capitation and FFS check runs, batch jobs, accumulators, Coordination of Benefits (including MOoP and TrOOP), EOBs, NDC/RxNorm Codes, DOFR, Pre-Authorizations, Reversal and Adjustments, Share of Cost, MOU; Membership – Enrollment, Medicare, Medi-Cal, Covered California, Dual eligibility, retro-active membership; Varied applications – QNXT, CCA, Syntranet, Mulesoft, SQL, EPIC, PCT, Salesforce.