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Edi Analyst Resume

Irving, TX

SUMMARY:

EDI Analyst with strong problem solving and analytical skills. My EDI Analyst experience is has provided me with a solid background in information systems technology and an extensive working knowledge of data communication protocols. Applying solid business analysis skills from inception to production to deliver quality software solutions that meet changing business requirements for end users. I also retain an understanding of clinic revenue cycle as it relates the EDI and financial software thus enabling me to analyze related processes to promote quality and cost effectiveness.

WORK EXPERIENCE:

EDI Analyst

Confidential, Irving, TX

Responsibilities:

  • Initiated and facilitated implementation of EDI Healthcare Claim Payments & Remittance (834, 835, and 837).
  • Managed setup and maintenance of payer connections including: Routes, maps, Trading Partner Management, assignment of payer IDs, FTP credentials, and portal logins.
  • Developed an internal payer database using advanced knowledge of Microsoft programs (Excel, Access, SQL), while maintaining working relationships and communications with external EDI departments and clearinghouse
  • Implemented knowledge of health care operations (Revenue Cycle) and utilized information system applications to aide in daily clinical operations, physician revenue cycle, and practice management

Benefits Verification Specialist

Confidential, Frisco, TX

Responsibilities:

  • Verified patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.
  • Documented and initiated prior authorization process and claims appeals.
  • Review current documentation related to the patients insurance verification and pharmacy care plan.
  • Flag/correct discrepancies that need to be addressed.
  • Communicated any reimbursement trends or delays to management, identified any coverage restrictions and provided details on how to expedite patient access.

EDI Analyst

Confidential, Shreveport, LA

Responsibilities:

  • Initiated, facilitated, and provided support for implementation/testing for EDI transactions 850, 856, 810, 845, 844, and 849 using ANSI X 12 file format.
  • Served as a liaison between the wholesaler and its vendors requesting transition to EDI while accommodating changes to meet federal guidelines thus reducing potential errors and remedying inefficiencies.
  • Accurately and efficiently generated and transmitted daily, weekly, and monthly chargeback documents and invoices to 500+ vendors which contributed to the overall operating of the company.
  • Analyzed and provided support for the design of EDI specifications to be used for enhancements for EDI applications, interfaces, and mappings in both a testing and production environment.
  • Exhibited exceptional analytical and critical thinking skills, I collaborated with management teams and provided support of multiple integrated systems
  • Monitored incoming and outgoing EDI transactions and provided support for management teams and vendors to efficiently resolve any transaction errors.

Human Resources Assistant

Confidential, Shreveport, LA

Responsibilities:

  • Assisted HR Team with on - boarding and integration tasks including pre-employment paperwork background checks and drug tests for new hires.
  • Provided support to recruiters and analyst with job postings, HRIS support, career fair coordinating candidate interviews, and setting up travel arrangements.
  • Utilized and maintained hard copy and electronic filing system (HRIS) to prepare correspondence reports and materials for publications and presentations.
  • Audited new hire training reports (i.e. Anti-Harassment employee handbook Safety program and Cybersecurity)
  • Managed calendars, scheduled meetings/conference calls, and prepared meeting agendas and compilation of meeting minutes.

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