PROFESSIONAL SUMMARY:

Successful EDI Analyst with numerous years of business operational experience in healthcare sector with also planning and implementation. Knowledgeable about business best practices, regulatory standards and optimal control systems. Applies trend and pattern knowledge tobring dramatic improvements. Managed system support issues with internal users and business trading partners. Analyzed specs, created transaction maps and setup communication for trading partners.

SKILL:

Business/Modeling Tools: Windows 10, Skype, WebEx, SharePoint, OneDrive for Business and Microsoft Office Suite (PowerPoint, Excel, Word) and Rational Rose Requirements

Management Tools: Rational Requisite Pro

Databases: SQL Server, Sybase, MS Access, Oracle

Operating Systems: Windows 95/98/2k/NT/XP/Vista/Window 7

Web Technologies: Java, JSP, VB Script, VB 6.0, HTML

Ticketing System: Zendesk, ServiceNow, and Jira E - Learning modalities and mobile interactive solutions

EDI Translators: Gentran/Sterling Integrator B2B, Open Text BizLink BizManager B2B, Trusted Link

EDI Standards: EDIX12(ANSI), ODETTE, HIPAA, Tradacoms

Mapping Tools: Sterling Map Editor, EDIFECS Spec Builder

WORK HISTORY:

EDI Analyst

Confidential, Plano, TX

Responsibilities:

• Successfully implemented company compliance with all EDI connections.
• Proficient in the EDI Healthcare claim billing and responses (837,834,999,276/277,270/271,835)
• Knowledgeable with the unique EDI requirements for Medicare, Medicaid and commercial payers
• Monitored EDI workflows to prevent errors
• Analyzed EDI processes and make recommendations for healthcare business - related and/or systems process improvements
• Maintained up to date documentation on each EDI customer contacts, specific rules for order exceptions, etc
• Maintained detailed documentation and process flow of all EDI processes
• Provided functional knowledge and technical support to the business unit through developed and ad hoc analysis/reporting, as well as designing new processes/reports
• Participated in the development and delivery of software applications, training programs and individual classes
• Developed and maintained cross walking and validation rules for file exchanges

EDI Test Analyst /Technical Support Consultant

Confidential, Miami, FL

Responsibilities:

• Responsible for the full cycle of EDI projects from initial contact, analysis of requirements, design of the solution, setup, creation and testing of maps and ongoing supported applications that EDI utilizes are SAP, and Tibco
• Participated as a technical team member in design, programming, and testing of EDI enhancements and projects
• Provided day-to-day support including problem resolution and coordination of operational activity relative to job scheduling, etc
• Devised data verification methods, participate in system integration testing, prepares test data, tests and debugs problems
• Responsible for compliance with applicable Corporate and Divisional Policies and procedures
• Strong understanding with practical experience in EDI and B2B. Familiar with EDI X12 standards, and SAP IDOC
• Collaborated with eClincial Works System Analyst and Developer for resolution on system issues which ensured the payment/denial process was adjudicated
• Identified functional problems with software and reserved logs on issues until guaranteeing resolution
• Supported management with daily and monthly reporting of trending information from applications

EDI Technical Implementation Analyst

Confidential, Atlanta , GA

Responsibilities:

• Developed and implemented EDI ANSI X12 transactions.
• Worked with internal and external trading partners, third party or business units to translate formats, ensure communication and facilitate the flow of new and existing transaction maps on B2B Gentran/Sterling Integrator or TLi/Bizmanager
• Implemented and supported electronic commerce solutions for business to consumer and business to business technologies
• Contributed to and played a key role in projects that encompass communications with EDI value added networks and direct connections
• Validated all the data maps and transaction sets in all EDI systems to facilitate the production move
• Monitored and troubleshoot the day to day transactions and took the necessary actions for any transaction failures including both inbound and outbound EDI documents

Help Desk Analyst

Confidential, Miami, FL

Responsibilities:

• Supported technology projects, including application testing, both pre and post deployment.
• Engaged end-users and answered questions via email, phone, website live chat and in forums.
• Asserted compliance controls for multiple systems, including regularly auditing AD groups and validating privileged accesses.
• Accountable for resolving infrastructure complaints and requests. · Provided level one triage for business applications, which include diagnosing issues, detecting patterns of impact, and ensuring the validity of complaints.
• Researched and documented program errors using CRM software system.
• Evaluated and tracked issues to ensure users receive a timely response.
• Knowledgeable of the Business products /enterprises.
• Constantly improved customers satisfaction through expert resolution of conflict, issues or concerns