Healthcare EDI & Implementation Lead

About Bluestone Health

Bluestone Health is building a more connected healthcare experience for employer groups and communities, including people in rural and remote areas where access to coordinated care is often limited. Our model brings together health plan administration, pharmacy benefits, primary care, specialty care, and care coordination so members are not left to navigate a fragmented system on their own.

We use software, data, and responsible AI to connect organizations and reduce avoidable gaps and administrative work. Our team is small and high-trust. People here communicate directly, take ownership, and follow work through to a confirmed result.

Why Now

Bluestone is preparing client and partner conversions for January 1, 2027 while supporting existing implementations. Each workstream needs clear requirements, approved mappings, aligned vendors, credible testing, and an accountable owner for launch readiness.

We need an experienced implementation lead who can own those conversations and decisions without requiring the CTO to translate every question. The initial engagement is deliberately time-bounded: deliver the conversions, stabilize the exchanges, and establish a sustainable operating handoff. An extension, including possible fractional support, will depend on confirmed implementation demand and ongoing change-management workload, not an assumed permanent position.

The Role

During the agreed engagement, you will own the client-facing process for assigned healthcare data and EDI implementations, coordinating employer groups, HRIS and benefits vendors, TPAs, enrollment platforms, and Bluestone's internal teams.

This is a technically fluent implementation role, not primarily a software-engineering job or a generic project coordinator position. You must be able to read file specifications, investigate mappings and account structures, identify ambiguous requirements, and drive decisions with the right domain owners. You do not need to personally build production pipelines or infrastructure.

You will convert discussions into usable requirements and implementation evidence: what data is expected, what each field means, who approves the rules, how the exchange will be tested, and what must be true before launch. A Data Engineer owns technical architecture, code, and production reliability. You own coordination, requirements clarity, readiness, and follow-through across organizations.

What You'll Own

• Client and vendor discovery: Lead meetings to establish source systems, exact product/version/module where relevant, available export or integration options, populations, business rules, dependencies, and timelines.
• EDI requirements: Understand eligibility/enrollment exchanges, including 834s and flat files, account structures, plan/rate codes, group identifiers, member/dependent relationships, effective dates, and full versus change files.
• Specifications and mapping coordination: Maintain interface requirements, source-to-target mapping documents, code dictionaries, open questions, approved decisions, and version history. Obtain authorized business approval and engineering review rather than inventing rules.
• Implementation planning: Keep each workstream's milestones, owners, dependencies, risks, and next actions visible. Coordinate clients, vendors, and internal reviewers to unblock work.
• Technical coordination: Arrange secure-transfer requirements such as SFTP access and encryption with engineering and approved administrators. Understand what is needed without assuming ownership of infrastructure or circulating secrets through unapproved channels. Engineering approves the technical design and implementation.
• Testing and acceptance: Coordinate test files, expected results, reconciliation evidence, defect tracking, retesting, business sign-off, and engineering readiness. Distinguish successful delivery from correct downstream acceptance.
• Cutover and stabilization: Maintain launch checklists, escalation contacts, contingency plans, and post-launch issue tracking. Keep clients informed of impact, owners, and next steps.
• Operational handoff: Deliver partner contacts, approved specifications, mappings, runbooks, known limitations, and escalation paths. Train operations on recurring checks and clarify what requires engineering or business approval.
• Post-launch change management: During the engagement, coordinate material plan, mapping, vendor, or file changes; assess impact and arrange approval, testing, and release.

Ownership Boundaries

You own the implementation process through acceptance and stabilization. You do not independently approve eligibility or benefit rules, write production transformations, design the data platform, or own analytical conclusions.

The Data Engineer owns technical implementation and reliability. Authorized client and internal business owners approve domain rules. Operations takes on documented recurring checks and routine follow-up once the handoff is accepted. The Analytics Lead owns reporting methods and interpretation.

Keep the client involved in vendor communications and decisions that affect its implementation. Escalate exceptions with evidence and a proposed next action rather than forwarding an unexplained thread. The role should reduce CTO mediation, not create another coordination layer that depends on it.

What We're Looking For

Required

• Experience owning healthcare, benefits, payer/TPA, HRIS, or related data-exchange implementations across multiple organizations.
• Working knowledge of healthcare eligibility/enrollment EDI, especially 834s, and the ability to interpret file specifications and mapping documents.
• Comfort examining structured files and spreadsheets, identifying mismatched codes or populations, and asking precise questions about source meaning.
• Experience leading client/vendor meetings, documenting decisions, managing dependencies, and driving open issues to closure.
• Practical understanding of testing, reconciliation, business acceptance, cutover, and post-launch stabilization.
• Ability to work independently on domain and coordination questions while recognizing decisions requiring engineering, business, or clinical authority.
• Strong written communication and clear, concise status reporting.
• Comfort working with sensitive healthcare information under approved privacy and security controls.
• U.S. residence, substantial overlap with the U.S. team, and availability during the agreed engagement window.

Strongly Preferred

• Employer benefits, TPA migrations, open enrollment, and benefit/eligibility effective-date experience.
• Experience coordinating with HRIS vendors such as UKG, enrollment platforms, carriers, and TPAs.
• Experience with plan/account structures, multi-entity client groups, dependent rules, and reconciliation of enrollment populations.
• SQL for validation and investigation; it is helpful, not a requirement to be a production developer.
• HIPAA, minimum-necessary access, secure file transfer, and audit evidence.
• A record of handing implementations into repeatable operating processes rather than retaining every routine issue.

Nice to Have

• Familiarity with claims or payment exchanges such as 837/835, PBM feeds, or other healthcare interfaces.
• Experience as an EDI analyst, implementation consultant, benefits integration specialist, or technical business analyst.
• Experience working in a small company with limited engineering capacity.

What Good Looks Like

Before launch, requirements and mappings are approved, test evidence is complete, unresolved risks are visible, and every dependency has an owner. After launch, discrepancies are resolved through documented decisions and verified corrections.

By the end of the engagement, operations can run established checks, engineering has supportable technical documentation, clients know their escalation paths, and recurring work no longer depends on the implementation lead or CTO remembering what was agreed.

Security and Responsible AI

This role involves protected health information and other sensitive data. Complete required security, privacy, and HIPAA training; use approved devices, systems, access methods, and credential-handling procedures. AI can assist documentation or research only within approved controls, and you remain responsible for verifying specifications, decisions, and communications.

Expected Hiring Process

1. Application or recruiter introduction.
2. Screening conversation covering implementation ownership, EDI fluency, availability, and engagement expectations.
3. Paid, time-bounded exercise using synthetic specifications and files: identify mapping ambiguities, develop questions, and outline a test/cutover plan.
4. Working session with technical and operational stakeholders reviewing the exercise and a realistic client/vendor scenario.
5. Final conversation agreeing scope, weekly commitment, duration, compensation, and logistics.

We aim to complete the process in approximately two weeks once interviews begin.

How to Apply

Send your resume and a brief note describing an implementation you owned across clients and vendors, a requirement or mapping issue you resolved, how you handed the work into operations, and your location, time zone, and availability.

We review applications personally. We do not use automated keyword screening to decide who gets considered.

Equal Opportunity

Bluestone Health is committed to providing equal employment opportunities without discrimination or harassment on the basis of race, color, religion, sex, gender, sexual orientation, gender identity, national origin, disability, age, veteran status, or any other status protected by applicable law.