EDI Analyst Resume Example
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EDI ANALYST
Professional Summary
Experienced healthcare information analyst looking to utilize my analytical and healthcare billing experience to help improve organizational processes. Seasoned healthcare analyst with 20+ years in the industry with a vast knowledge of billing requirements. Extensive analytical skills developed through experience and education. Strong implementation skills. Excellent problem solving skills with the ability to identify issues and implement corrective processes.
Skills
- Business relationship development
- Report analysis
- Root Cause Analysis
- Accounts receivable
- Business processes
- Month-End Closing
- Contracts
- Version control
- CPT4
- ICD-9
- Microsoft Office
- SQL
- User training
Education
DeVry UniversityCity06/2013Bachelors of Science:Computer Information Systems, Systems Implementation and Analysis
- Leadership Award for working with administration to integrate new students.
- Graduated as a member of the Magna Cum Laude
Work History
1-800-Flowers.Com, Inc.- EDI Analyst
Westerville , OH01/2015 - Current
Westerville , OH01/2015 - Current
- Tracked 27x and 835 files from origin to destination and troubleshot errors.
- Transmitted records and files to customers efficiently to maintain operational timelines.
- Analyze large 27x and 835 transaction sets for accuracy.
- Review payer specifications for updates.
- Create Companion Extract for new payer plans for 27x transactions.
- Create documentation detailing steps needed to be taken to update payer information for 27x transactions.
- Perform SQL queries to review data being returned to providers.
- Implement version control standards.
1-800-Flowers.Com, Inc.- EDI Analyst
Atlanta , GA06/2010 - 08/2014
Atlanta , GA06/2010 - 08/2014
- Create 837P and 837I files for transmission of 2,000 claims daily to clearinghouse.
- Tracked 837 files from origin to destination and troubleshot errors.
- Reconcile claims submission spreadsheet.
- Resolve rejections that result from claim submission.
- Work with claims clearinghouse to resolve issues with payers.
- Break down 837 files to identify discrepancies in file format and content and apply changes as necessary.
- Recognize system issues as they arise.
- Research and work with payers to determine if system changes are necessary.
- Monitor industry changes as they relate to organizational practices.
- Maintain File Maintenance files for multispecialty practice with 300+ providers with 60+ locations.
- Review end user work flows to employ system changes to streamline processes, improving functional efficiency.
- Prepare and analyze system reports to review with management for possible business concerns.
- Regression testing for system upgrades.
- Prepare end user training material using PowerPoint to explain system changes.
- Successful 5010 implementation while maintaining monthly revenue of $8 million.
- Preparation training and system testing for ICD-10 compliance.
- Built and deepened positive and productive relationships with business partners.
Accounting And Consulting Group, Llp- Implementation Specialist
Enterprise , AL01/2010 - 04/2010
Enterprise , AL01/2010 - 04/2010
- Implemented NextGen Practice Management System for nationwide physiotherapy group with 600+ office locations.
- Analyzed current business practices to determine how they would apply in the new practice management system.
- Supervised and trained implementation team to ensure proper execution.
- Developed guidelines for creation of new payers, providers and locations as needed for growth.
- Created spreadsheets of 300+ payer contracts per regional area and imported into practice management system.
- Incorporated new practice flow for end users.
- Produced training materials and educated end users to properly use new practice management system.
Cardiovascular Associates Of SE Pa- Electronic Claims Analyst
City , STATE01/1999 - 12/2009
City , STATE01/1999 - 12/2009
- Maintained File Maintenance files for 50 physician cardiology practice with 12 locations.
- Transmitted claims 837P files with approximately 300 daily claims to clearinghouse for processing.
- Developed and maintained claims reconciliation spreadsheet to track accepted and rejected claims.
- Worked rejection reports retrieved from clearinghouse.
- Created and maintained month end reports for review by management.
- Assisted in month end closing.
- Created and maintained system reports for analysis of payer trends.
- Implemented changes within practice management system as needed to resolve issues.
- Member of core team implementing new practice management system.
- Reviewed current business processes and system setup to determine how they would be incorporated into the new system.
- Developed new business process flows as needed for implementation.
- Helped to develop new organizational policies and procedures to be followed by all areas within the organization.
- Worked with new claims clearinghouse to set up proper claims submission to all applicable payers and made adjustments to system files as needed.
- Maintained old practice management system to clean up outstanding accounts receivable.
- Identified key areas not performing well and implemented effective, new processes.
- Interacted with clients and employees, which helped cultivate positive working relationships.
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Resume Overview
School Attended
- DeVry University
Job Titles Held:
- EDI Analyst
- Implementation Specialist
- Electronic Claims Analyst
Degrees
- Bachelors of Science : Computer Information Systems, Systems Implementation and Analysis
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