EDI Business Analyst lll Resume Example
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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
|
Experience
January 2003
to
January 2015
Suny PlattsburghPlattsburgh , NYEDI 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 UniversityCity, PhilippinesBachelor of Science: Chemical EngineeringChemical Engineering
Santiago SDS, INCCity, StateHIPAA 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
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Resume Overview
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
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