MAKE A DIFFERENCE AT OCHIN

OCHIN is a nonprofit leader in health care innovation and a trusted partner to a growing national provider network, delivering the clinical insights and tailored technologies needed to expand patient access, strengthen care teams, and improve the health of rural and medically underserved communities.

We are hiring a number of new positions to meet increasing demand. When you choose to join OCHIN, you have the opportunity to continuously grow your skills and do meaningful work to help fulfill our vision of good health and well-being for everyone. 

At OCHIN, we value the unique perspectives and experiences of every individual and work hard to maintain a culture rooted in our values. 

Founded in Oregon in 2000, OCHIN employs a growing virtual workforce of more than 1,400 skilled professionals, working remotely across 49 states. We offer a generous compensation package and are committed to supporting our employees’ entire well-being by fostering a healthy work-life balance and opportunity for professional advancement. We are curious, collaborative learners who strive to live our values every day. OCHIN is excited to support our continued national expansion and the increasing demand for our innovative tools and services by welcoming new talent to our growing team. 

Work Authorization

Candidates must be legally authorized to work in the United States on a permanent basis at the time of application.

This position is not eligible for employment visa sponsorship now or in the future. OCHIN does not provide sponsorship for employment-based visas or transfers of existing employment-based visas.

Position Overview

The Manager, Clearinghouse Operations is responsible for the strategic oversight and day-to-day management of clearinghouse operations, healthcare organization onboarding, electronic data interchange (EDI) transaction performance, and clearinghouse vendor relationships. 

This role
leads the team responsible for the accurate and timely submission of electronic healthcare claims to third-party clearinghouses, such as Experian Health, TriZetto, Quadax, and other EDI service providers. The Manager also oversees the retrieval, reconciliation, and distribution of electronic remittance advice, eligibility transactions, claim status inquiries, transaction acknowledgments, and related revenue cycle transactions. 

The Manager serves as the operational and technical leader for clearinghouse connectivity, transaction management, healthcare organization implementations, payer enrollment, and vendor performance. This position works closely with members, payers, clearinghouse vendors, Revenue Cycle, Information Technology, and practice management teams, and other internal stakeholders to ensure successful implementations and reliable ongoing operations. 

The Manager is accountable for maintaining high levels of claims processing accuracy, transaction performance, revenue cycle efficiency, customer service, and regulatory compliance. This role requires extensive technical expertise in healthcare clearinghouse operations, strong project and implementation management capabilities, and demonstrated experience managing external vendors and strategic business relationships. 

Essential Duties

Clearinghouse and EDI Operational Leadership 

• Lead the daily operations of the clearinghouse function, ensuring the accurate and timely processing of claims, remittances, and other healthcare EDI transactions. 
• Supervise and develop the team responsible for:  
• Electronic claim submission, monitoring, and reconciliation. 
• Electronic remittance advice and 835 file retrieval, reconciliation, and distribution. 
• Eligibility, claim status, acknowledgment, and other EDI transaction management. 
• Clearinghouse rejection, exception, and work queue management. 
• Payer connectivity and electronic transaction enrollment. 
• Revenue cycle transaction monitoring and performance reporting. 
• Operational and technical issue investigation and resolution. 
• Establish and maintain operational standards, workflows, standard operating procedures, service-level expectations, and escalation processes. 
• Monitor clearinghouse queues, acknowledgment files, transmission reports, rejection worklists, and transaction volumes to identify and resolve issues proactively. 
• Lead root cause analysis and corrective action planning for recurring transaction failures, claim rejections, payer connectivity issues, and processing delays. 
• Ensure appropriate operational controls are in place to validate the receipt, reconciliation, and distribution of inbound and outbound transactions. 
• Develop business continuity and contingency processes to mitigate the impact of clearinghouse outages, vendor disruptions, and transaction failures. 
• Drive continuous improvement initiatives that increase transaction accuracy, reduce manual effort, and improve processing timeliness. 

Healthcare Organization Onboarding and Implementation Management 

• Lead implementation projects for onboarding new healthcare organizations to clearinghouse services and expanding services for existing organizations. 
• Manage multiple concurrent implementations involving claims, remittances, eligibility, claim status, payer enrollment, and other healthcare EDI transactions. 
• Develop comprehensive implementation plans that define scope, milestones, timelines, resource requirements, dependencies, risks, testing requirements, and success measures. 
• Coordinate implementation activities across healthcare organizations, payers, clearinghouse vendors, Revenue Cycle, Information Technology, EHR and practice management teams, and other operational stakeholders. 
• Establish clear project governance, decision-making processes, meeting cadences, escalation paths, and status reporting expectations. 
• Facilitate implementation meetings and provide concise status reporting to operational and executive stakeholders. 
• Oversee payer enrollment, connectivity setup, system configuration, data mapping, testing, validation, migration, and production deployment activities. 
• Ensure claims, remittances, acknowledgments, and related transactions are successfully tested and validated before production deployment. 
• Establish implementation readiness criteria and ensure operational ownership, documentation, training, and support processes are in place before transition to ongoing operations. 
• Identify implementation risks and dependencies early, establish mitigation plans with clear owners and target dates, and escalate issues that may affect timelines, operational readiness, or financial performance. 
• Monitor post-implementation performance and lead stabilization activities to ensure transaction accuracy, issue resolution, and a successful transition to operational support. 
•  Conduct post-implementation reviews to document outcomes, lessons learned, and opportunities to improve future onboarding efforts.  

Vendor and Strategic Relationship Management 

• Serve as the primary relationship owner for clearinghouse vendors, EDI service providers, revenue cycle technology partners, and payer connectivity partners. 
• Manage strategic relationships with vendors such as Experian Health, TriZetto, Change Healthcare, Availity, and other clearinghouse or EDI service providers. 
• Establish clear service expectations and hold vendors accountable for contractual obligations, service-level agreements, implementation commitments, issue resolution, system availability, and transaction performance. 
• Lead regular operational reviews and strategic business reviews with vendors to evaluate performance, address risks, review roadmaps, and identify improvement opportunities. 
• Develop and maintain vendor scorecards that measure:  
• System availability and service reliability. 
• Transaction acceptance and success rates. 
• Incident volume and severity. 
• Issue response and resolution times. 
• Implementation milestone performance. 
• Service-level agreement compliance. 
• Customer service and escalation effectiveness. 
• Escalate critical vendor issues and coordinate cross-functional resolution efforts to minimize operational disruption, customer impact, and financial risk. 
• Partner with Procurement, Legal, Finance, Information Security, Revenue Cycle, and Information Technology on vendor selection, due diligence, contract reviews, renewals, amendments, and performance management. 
• Support contract negotiations by identifying operational, technical, service-level, security, and implementation requirements.  
• Evaluate vendor capabilities, emerging clearinghouse technologies, automation opportunities, and alternative service models to improve performance, scalability, cost effectiveness, and customer experience. 
• Collaborate with vendors on system enhancements, troubleshooting, payer connectivity, product roadmaps, and implementation activities. 
• Manage enhancement requests and advocate for organizational and healthcare organization priorities. 
• Develop mitigation and contingency plans for vendor outages, service disruptions, security events, and other operational risks. 
• Ensure vendors maintain compliance with contractual, regulatory, privacy, security, and business continuity requirements. 
• Identify opportunities to improve vendor value, reduce unnecessary costs, consolidate services, and optimize transaction processing. 

Revenue Cycle Performance and Process Improvement 

• Partner with Revenue Cycle, Billing, Coding, Finance, and operational teams to improve clean claim performance, decrease rejections, and reduce avoidable denials. 
• Analyze clearinghouse and transaction data to identify trends affecting claim acceptance, reimbursement, cash flow, and customer experience. 
• Develop and implement strategies to improve first-pass claim acceptance and reduce claims held or rejected because of clearinghouse, payer, configuration, or enrollment issues. 
• Identify automation opportunities that reduce manual intervention and improve transaction processing efficiency. 
• Collaborate with internal teams and vendors to optimize payer routing, claim edits, acknowledgment handling, remittance processing, and exception workflows. 
• Establish measurable improvement targets and monitor whether corrective actions produce the intended operational and financial outcomes. 
• Support broader organizational initiatives focused on revenue cycle optimization, service delivery, and financial performance. 

System Configuration and Technical Management 

• Collaborate with EHR, practice management, Revenue Cycle, Information Technology, interface, and vendor teams to configure and maintain clearinghouse integrations. 
• Ensure accurate configuration of payer routing, claim edits, enrollment records, transaction workflows, file delivery methods, and trading partner connections. 
• Lead or support clearinghouse migrations, platform upgrades, payer changes, service expansions, acquisitions, and system implementations. 
• Partner with technical teams to troubleshoot interface failures, data transmission errors, mapping issues, file processing problems, and system defects. 
• Participate in the design, testing, validation, and deployment of clearinghouse system enhancements and upgrades. 
• Ensure technical and operational documentation remains current, complete, and accessible. 
• Translate complex clearinghouse and EDI issues into clear business impacts, decisions, and action plans for operational and executive stakeholders. 

Reporting, Analytics, and Performance Management 

• Develop and maintain dashboards, vendor scorecards, implementation reports, and operational performance reporting. 
• Monitor performance trends and use data to identify risks, recurring issues, improvement opportunities, and resource needs. 
• Establish clear definitions, data sources, targets, and ownership for all clearinghouse and implementation performance measures. 
• Monitor key performance indicators, including:  
• Clean claim rate.  
• First-pass claim acceptance rate. 
• Clearinghouse and payer rejection rates. 
• Eligibility and claim status transaction success rates. 
• ERA and EFT enrollment and adoption. 
• Claims held in clearinghouse or interface queues. 
• Unreconciled or undistributed remittance files. 
• Transaction processing timeliness. 
• Vendor system availability and SLA performance. 
• Implementation milestone achievement. 
• Implementation defect and issue volume. 
• Aging of unresolved operational and vendor issues. 
• Escalation response and resolution times. 
• Reconcile performance data across operational, vendor, and leadership reporting to ensure accuracy and consistency. 
• Present clear updates to leadership on performance, risks, implementation status, vendor issues, mitigation plans, and decisions needed. 
• Ensure risks and issues include defined owners, next actions, target dates, and a measurable path to resolution. 

Compliance and Risk Management 

• Ensure clearinghouse operations comply with HIPAA, CMS requirements, ANSI X12 standards, payer requirements, contractual obligations, and organizational policies. 
• Maintain appropriate controls, documentation, audit trails, operating procedures, and reconciliation processes. 
• Monitor healthcare industry, payer, regulatory, and EDI changes that may affect electronic transaction processing. 
• Coordinate with Compliance, Privacy, Information Security, Legal, and operational teams to evaluate and respond to applicable changes. 
• Identify operational, technical, vendor, implementation, security, and compliance risks and establish mitigation plans. 
• Support internal and external audits, security assessments, compliance reviews, and corrective action activities. 
• Ensure team members understand and consistently follow privacy, security, regulatory, and operational requirements. 

Team Leadership and Development 

• Hire, coach, mentor, and develop a high-performing clearinghouse operations and implementation team. 
• Establish clear roles, performance goals, service expectations, and accountability measures. 
• Conduct regular performance discussions and annual performance evaluations. 
• Provide guidance and escalation support for complex operational, technical, implementation, client, payer, and vendor issues. 
• Foster a culture of accountability, customer service, operational excellence, transparency, collaboration, and continuous improvement. 
• Assess team capacity and capabilities and develop workforce plans that support operational demand and implementation volume. 
• Identify training needs and establish skill development plans for clearinghouse operations, EDI transactions, technical troubleshooting, implementation management, and vendor oversight. 
• Develop succession plans and growth opportunities for team members. 
• Promote effective collaboration across Revenue Cycle, Information Technology, EHR and practice management teams, Customer Experience, Finance, Legal, Compliance, and other organizational functions. 
• Other duties as assigned.? 

• Minimum of four years (4) of hands-on technical experience working directly with healthcare clearinghouses or within a healthcare clearinghouse organization. 
• Demonstrated experience managing electronic claim submission, acknowledgment, rejection, remittance, and reconciliation workflows using platforms such as Experian Health, TriZetto, Change Healthcare, Availity, or comparable clearinghouse vendors. 
• Minimum of three (3) years of leadership or supervisory experience managing operational, implementation, or technical teams. 
• Proven experience leading the onboarding and implementation of healthcare organizations into a clearinghouse environment. 
• Demonstrated ability to manage multiple concurrent client or healthcare organization implementation projects. 
• Strong project management experience coordinating cross-functional teams, vendors, clients, payers, and technical stakeholders. 
• Demonstrated vendor management experience, including SLA oversight, vendor performance reviews, issue escalation, contract support, and relationship management. 
• Experience supporting healthcare revenue cycle operations and EDI transaction processing. 
• Strong knowledge of electronic claims processing, payer connectivity, eligibility transactions, claim status transactions, remittance processing, and healthcare reimbursement methodologies. 
• Working knowledge of HIPAA, CMS requirements, ANSI X12 transaction standards, and healthcare data privacy and security requirements. 
• Experience working with EHR, practice management, billing, or revenue cycle technology platforms. 
• Demonstrated analytical, problem-solving, technical troubleshooting, and process improvement capabilities. 
• Strong written and verbal communication skills, including the ability to communicate complex technical and operational issues to varied audiences. 
• Proficiency in Smartsheet or similar project management system preferred 
• Working knowledge of Microsoft Word, Excel, PowerPoint is required 

Base Pay Overview 

OCHIN uses broadened pay ranges to support equitable and market-aligned compensation practices. The final offer will be based on a variety of factors, including relevant skills, certifications, education, experience, training, responsibilities, internal equity, and market data.

Physical Requirements/Work Environment:

• Constant interpersonal skills, teamwork, and customer service. Frequent creativity, mentoring, presentations/teaching. Occasional decision making and independent judgment or action. 
• Reading, speaking, writing, and understanding English. 
• While performing the duties of the job, the employee is regularly required to sit for long periods of time; stand and walk; use hands to finger, handle or feel; reach with hands and arms.
• This position requires a virtual home-office environment, working remotely and will require that employees be on camera for all virtual meetings.
• The role routinely uses standard office equipment such as computers and mobile devices. 
• Up to 25% Travel may be required to support OCHIN’s business requirements for which may require travel by air, vehicle, or train. 

COVID-19 Vaccination Requirement

To keep our colleagues, members, and communities safe, OCHIN requires all employees—including remote employees, contractors, interns, and new hires—to be vaccinated with a COVID-19 vaccine, as supported by state and federal public health officials, as a condition of employment. All new hires are required to provide proof of full vaccination or receive approval for a medical or religious exemption before their hire date.

Work Location and Travel Requirements

OCHIN is 100% remote organization. Work from home requirements are: 

• Ability to work independently and efficiently from a home office environment
• High Speed Internet Service
• It is a requirement that employees work in a distraction free workplace
• Travel may be required to support our member organizations on-site based on business requirements for OCHIN

We offer a comprehensive range of benefits. See our website for details: https://ochin.org/employment-openings

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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