EDI Business Analyst Lll Resume Example EMDEON

EDI BUSINESS ANALYST LLL

Professional Summary

Experienced Healthcare EDI Claims Business/Systems/Data Analyst with over 12 years of comprehensive experience in a clearinghouse environment. Highly knowledgeable in IT areas specially production, research as well as business principles. Demonstrated success and proven ability to monitor over 300 payers and troubleshoot critical issues resulting in the recovery of claims revenue. Familiar with a variety of communication protocols such as FTP/SFTP, VPN, BBS, HTTP/HTTPS used in Payer data communication and SQL.

Core Qualifications

Mainframes - IBM3090, 4341, 4361, 4381
Mini-Computers - AS/400
Personal Computers - IBM-Compatible PCs
Software:
Operating Systems - OS/400, OS/MVS, DOS/VSE, MSDOS, PC DOS, OS/2
Languages - COBOL, COBOL/400, RGP111/RPG400, DDS, CL, RPG/ILE
Others - XEDIT/ULTRAEDIT, SQL, WORD, EXCEL, ACCESS
Applications:
Healthcare, Census, General Accounting, Payroll, Order Processing, Inventory

Experience

January 2003

January 2015

EMDEONSanta Ana, CAEDI Business Analyst lll

A provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers, and patients in the U.S.
Healthcare System.
Claims Analysis Monitored daily claim transactions to and from the payer by ensuring acknowledgements were returned by the payer (ex.
Electronic reports (997/999, 277/277CA, Proprietary reports), verbal, e-mail acknowledgments, in-house logs, etc) for every daily outbound (837P, 837I, 837W) files.
Hands-on in detailed analysis of EDI transactions, claim data error/s reported by the payers, determined claims affected by the issues, resolved the errors, corrected and ALEGRIA E.
TENORIO h- 714 995-1207 c-714 496-3952 re-submitted failed files/batches through front-end edits thereby reducing rejections of claims at the front-end, ensuring payments and increasing claims revenue.
Research Analysis Coordinated with Development and Integration Architecture teams to align the clearinghouse's front-end validations with that of the payer.
Provided technical support both in-house and external on EDI issues with enrollment, claims/tracking, payments, and/or clearinghouse activities.
Effective liaison between healthcare clearinghouses and payers resulting to successful claims processing using Microsoft products (Word, Excel, Access) and Salesforce.
Assisted other teams in transitions and implementations of payers to 5010 or new payer routing using extensive knowledge of ANSI X12N 5010 HIPAA transaction set formats 837, 277/277CA, 997/999 and working knowledge of 835, 270/271, NSF formats, mapping, Implementation Guides, Companion Documents, HIPAA Standards.
Coordinated with payers on changes that affect transmissions and claims processing and request edits via Salesforce to address the cause of HIPAA compliancy or transmission failures.
Production Analysis Monitored the in-house Batch and File Level Payer Report Processing (INS).
This process handles all payer reports (997/999, 277/277CA) for parsing.
Performed troubleshooting issues on parsing and address them internally or with the payers.
Managed reports/acknowledgements (997s, Summary Reports, proprietary reports) to and from the payers site via communication protocol set-up between clearinghouse and the payer using in-house Payer Communications System (PCS).

Beech Street Corporation/HealtheonAnalyst/Programmer

Implemented and supported the company's Employee Identification System (EIS) involving design and analysis, heavy coding in COBOL/400, user testing, training and documentation.

Comprehensive Care CorporationProgrammer/Analyst

Assisted manager in maintaining healthcare and financial system.
Created instructions/documentations.
Programmer/Analyst at Pacificare.
Worked as a contractor with a team supporting Enrollment.

Education

Adamson UniversityManila, PhilippinesBachelor of Science: Chemical EngineeringChemical Engineering

Santiago SDS, INCLaPorte, INHIPAA Privacy and Security Training In-house Payer Communications System (PCS) Salesforce SQL Training Medicare Seminar, Anaheim Convention Center Certifications DB2 Application Design and Programming, Australian Institute of Management/Phoenix Contracting (Education) P/L, Sydney, Australia Certificate in AS/400 Programming, Midrange Systems & Solutions P/L, Sydney, Australia Certificate in Medical Insurance Billing and Coding Southeast ROP, Cerritos, CA Certificate in Medical Billing

Skills

General Accounting, Analyst, Application Design, AS/400, Billing, c, CL, COBOL, COBOL/400, CA, Hardware, DDS, documentation, DOS/VSE, EDI, e-mail, financial, IBM3090, IBM-Compatible PCs, DB2, MVS, Insurance, Inventory, Languages, Mainframes, Medical Billing, Microsoft products, ACCESS, EXCEL, exchange, Word, MSDOS, NSF, Operating Systems, OS, OS/2, OS/400, Payroll, PC DOS, Coding, Programmer, Programming, Research, routing, RPG, RPG400, SQL, technical support, transmission, troubleshooting, XEDIT

Resume Overview

Companies Worked For:

EMDEON
Beech Street Corporation/Healtheon
Comprehensive Care Corporation

School Attended

Adamson University
Santiago SDS, INC

Job Titles Held:

EDI Business Analyst lll
Analyst/Programmer
Programmer/Analyst

Degrees

Bachelor of Science : Chemical Engineering
HIPAA Privacy and Security Training In-house Payer Communications System (PCS) Salesforce SQL Training Medicare Seminar, Anaheim Convention Center Certifications DB2 Application Design and Programming, Australian Institute of Management/Phoenix Contracting (Education) P/L, Sydney, Australia Certificate in AS/400 Programming, Midrange Systems & Solutions P/L, Sydney, Australia Certificate in Medical Insurance Billing and Coding Southeast ROP, Cerritos, CA Certificate in Medical Billing

EDI Business Analyst lll Resume Example

Resume Score: 90%

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