The Healthcare EDI (Electronic Data Interchange) Product Owner is responsible for the strategic direction, development, enhancement, and operational performance of healthcare EDI solutions that support payer, provider, and vendor integrations. This role serves as the liaison between business stakeholders, operations, technology teams, and external trading partners to ensure EDI products meet organizational goals, regulatory requirements, and customer needs. The Product Owner manages the product backlog, defines business requirements, prioritizes enhancements, and drives delivery of EDI capabilities supporting healthcare transactions such as claims, eligibility, enrollment, remittance, authorizations, and provider data exchange.
Key Responsibilities
Product Strategy & Ownership
- Define and communicate the vision, roadmap, and priorities for healthcare EDI products and services.
- Own the EDI product backlog and prioritize features, enhancements, defects, and technical debt.
- Collaborate with business leaders to align EDI initiatives with organizational objectives.
- Evaluate industry trends, regulatory changes, and emerging technologies to drive product innovation.
Stakeholder Management
- Partner with business operations, claims, enrollment, provider services, finance, compliance, and IT teams to gather requirements and define solutions.
- Act as the primary point of contact for EDI-related product decisions and issue resolution.
- Facilitate communication between internal stakeholders and external trading partners, vendors, and clearinghouses.
Requirements & Delivery
- Develop detailed business requirements, user stories, acceptance criteria, and process flows.
- Lead backlog grooming, sprint planning, and product demonstrations within Agile environments.
- Ensure solutions meet business needs, quality standards, and regulatory requirements.
- Support User Acceptance Testing (UAT) and production implementation activities.
Healthcare EDI Operations
- Oversee EDI transaction processing and integration performance.
- Monitor and improve transaction quality, accuracy, and timeliness.
- Support implementation and maintenance of healthcare transaction sets including:
- 837 Claims
- 835 Remittance Advice
- 270/271 Eligibility Inquiry and Response
- 276/277 Claim Status
- 278 Prior Authorization
- 834 Enrollment
- NCPDP Pharmacy Transactions (as applicable)
- Coordinate onboarding and testing of new trading partners.
Compliance & Governance
- Ensure EDI products comply with HIPAA, CMS, state regulations, and organizational standards.
- Partner with compliance and audit teams to support regulatory initiatives and remediation efforts.
- Maintain documentation, process standards, and governance controls.
Performance & Analytics
- Define and monitor key performance indicators (KPIs) for EDI operations and product performance.
- Analyze transaction trends, error rates, and operational metrics to identify improvement opportunities.
- Drive continuous improvement initiatives that increase automation, efficiency, and customer satisfaction.
Required Qualifications
- Bachelor's degree in Business, Healthcare Administration, Information Systems, Computer Science, or related field; equivalent experience may be considered.
- 5+ years of healthcare EDI, claims processing, enrollment, or healthcare systems experience.
- 3+ years of Product Owner, Product Manager, Business Analyst, or equivalent leadership experience.
- Strong knowledge of HIPAA X12 transactions and healthcare data exchange standards.
- Experience working with healthcare payer, provider, TPA, or managed care organizations.
- Experience managing Agile projects and product backlogs.
- Strong analytical, problem-solving, and communication skills.
Preferred Qualifications
- Experience with healthcare core administration platforms such as:
- QNXT
- Facets
- HealthRules
- GuidingCare
- Certified Scrum Product Owner (CSPO) or Agile certification.
- Knowledge of Medicare, Medicaid, and Commercial health plan operations.
- Experience with EDI gateways, clearinghouses, and integration platforms.
- Familiarity with SQL, data analysis, and reporting tools.
Key Competencies
- Product Ownership
- Healthcare EDI Expertise
- Agile Methodologies
- Business Process Analysis
- Stakeholder Management
- Strategic Planning
- Regulatory Compliance
- Vendor Management
- Data Analysis
- Communication & Leadership
Sample Job Title Variations
- Senior Healthcare EDI Product Owner
- Healthcare EDI Product Manager
- EDI Integration Product Owner
- Healthcare Interoperability Product Owner
- Healthcare Data Exchange Product Owner
- EDI & Trading Partner Product Owner
Salary Range
Now, a little about us …
At Tegria, we bring bold ideas and breakthroughs to improve care, technology, revenue, and operations in ways that move healthcare organizations from patient-centered to human-centered. We are helping healthcare put people first—both patients and those who dedicate their lives to delivering care.
And at the very core of this vital work is our incredibly talented people.
People with different backgrounds who welcome challenge and change. People who listen first, ask hard questions, and make decisions to cultivate a culture of equity and inclusion. People who chase after goals, growth, and generosity. We’re real. We’re nimble, and we believe in our mission to humanize healthcare.
Perks and benefits
Top talent deserves top rewards. We’ve carefully curated a best-in-class benefits package, meant to meet you wherever you are in your life and career.
Your health, holistically. We offer a choice of multiple health and dental plans with nationally recognized networks, as well as vision benefits, a total wellness program, and an employee assistance program for you and your family.
Your financial well-being. We offer competitive wages, retirement savings plans, company-paid disability and life insurance, pre-tax savings opportunities (HSA and/or FSA), and more.
And everything in between. Our lifestyle benefits are unrivaled, including professional development offerings, opportunities for remote work, and our favorite: a generous paid-time-off program, giving you the flexibility to plan a vacation, take time away for illness (or life’s important events), and shift your schedule to accommodate those unexpected curve balls thrown your way.
Tegria is an equal employment opportunity employer and provides equal employment opportunities (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. All qualified candidates are encouraged to apply.
