Data/Business Analyst Resume New York, NY - Hire IT People

SUMMARY:

Strong knowledge of HIPPA ANSI 5010 Healthcare X12 EDI Transactions (834 enrolment, 820 payment, 837I and 837P - Institutional and Professional Claims, 835 Healthcare Payment Advice, 277CA Claim Acknowledgment, 999 Transaction)
Proved working knowledge of New Medicare Card (MBI, formerly known as SSNRI) testing
Knowledge of IBM Mainframe
Testing, troubleshooting and supporting of EDI files.
Troubleshooting Healthcare EDI transactions
Proficiency in Microsoft software applications such as Word, Excel, PowerPoint, Access, Outlook, Visio and SQL

TECHNICAL SKILLS:

Methodologies: Agile, Waterfall

Microsoft Office: MS Word, Excel, Power Point, Outlook, Visio, Access, SQL

PROFESSIONAL EXPERIENCE:

Confidential, New York, NY

Database Analyst/Government Programs

Working with management to establish, document and maintain EDI procedures by identifying errors and taking corrective action, reconciling EDI transactions through coordination of information with internal and external customers, Accounting Department, IT Department and external vendors to maintain EDI integrity.
Monitoring the uploading and downloading of eligibility files between mainframe and PC including compiling error reports and communicating with Trading Partners, Vendors, Medicare contractors, and CMS.
Monitoring the daily receipts and processing of claim files from Medicare contractors along with troubleshooting and resolving data transmission or content problems.
Performing analysis based on claim crossover inquiries related to eligibility files and billing.
Identifying, establishing and maintaining business relationships with internal and external trading partners and business partners.
Performing other duties in support of the organization mission as directed by management.
Assisting the IT Department by performing User Acceptance Testing on system enhancements prior to being moved into production.
Closely working with the Trading Partners to ensure they have a smooth transition from testing to production.
Monitoring Trading Partners to ensure testing is completed in the timeframe allotted.
Facilitating the resolution of any identified data file transmission and transaction errors including verification that all communication links and interfaces are working correctly and communicating appropriately.

Confidential, New York, NY

EDI Analyst/Government Programs

Monitoring, auditing and reporting on the processing of newly implemented Trading Partners to confirm their successful transition to the Testing and Production environment.
Managing the technical efforts associated with implementing complex EDI Trading Partners.
Engaging process in new Medicare Card (MBI) project (formerly known as SSNRI) testing with State Medicaid Agencies or their fiscal agents/intermediaries
Monitoring the Production environment and proactively prioritize, communicate, and resolve any EDI process or system issues.
Troubleshooting of issues impacting successful receipt or delivery of files
Working with Trading Partners to resolve any operational issues
Supporting Trading Partners with their non-standard requests for testing analysis and other technical deliverables
Ensuring compliance with HIPAA regulations and requirements
Monitoring daily transmission and processing of eligibility and claims files from and to CMS and Trading Partners
Facilitating monthly conference calls with States of Medicaid’s and Centers for Medicare & Medicaid Services (CMS)
Ensuring State Medicaid’s MCOs, PIHPs or PAHPs sign up for the COBA Medicare crossover process and participate in the automated crossover process administered by Medicare.
Providing quality customer service.
Maintaining the integrity of the Medicare trust funds.
Testing, troubleshooting and supporting of EDI files.
Building and maintaining positive working relationships with management, internal colleagues (including IT Department and Accounting Department) and external contacts

Confidential, New York, NY

Health Care Data Analyst

Analyzed medical and pharmaceutical claims data sets to discover pattern, test assumption and uncover new opportunities
Gathered requirements, designed new reporting packages
Created technical specification documents
Helped write the necessary SQL code
Responsible for insuring data quality and appropriate data use to comply with HIPPA regulation
Researched data anomalies, duplicating data, missing data and other quality data issues
Presented data quality results to team members and business subject matter experts and was able to defend analysis techniques and results
Assisted two-sided shared risk program implementation
Developed baseline information on member population assessment and provider utilization patterns
Interacted with senior analysts in responding to two-sided shared risk contract managers to ad hoc data and analytical requests in support of the program and relationship management
Collaborated with senior analysts, medical directors and care management ream

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Data/business Analyst Resume

New York, NY

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