EDI Analyst/Operations Technician Resume Nashville, TN - Hire IT People

SUMMARY

Extensive Confidential EDI and X12 transactions knowledge coupled with sustained HIPAA privacy and security compliance .
Articulate communicator and creative problem solver with the ability to identify and prioritize deliverables against risks and design viable solutions.
Solutions driven analytical performer comfortable working independently or as a group effort participant in a key coordinator role with strong actionable decision making.
Knowledge hungry self starter coupled with highly refined business comprehension demonstrated by repeated success in the analysis and management of innovative EDI solutions that directly promote business growth .

TECHNICAL SKILLS

Systems Knowledge:

PROFESSIONAL EXPERIENCE

Confidential, Nashville, TN

EDI Analyst/Operations Technician

Responsibilities:

Test and troubleshoot customer X12 EDI transactions; primarily 834, 835, 837I, 837P, 270/271, 276/277, 277CA, Encounter data & 999 files.
Monitor daily EDI transactional logs and document all failed translation processes.
Spearheaded the conversion with external trading partners.
Monitor and documents all EDI requests and track all applications and participate in IT meetings on weekly basis and monitor progress for same in coordination with IT director and plan effective solutions.
Evaluate all business processes and monitor transactions to resolve all lost transactions and perform tests on EDI maps.
Supervise and support the day - to-day functions of IT Operations Computer Operators.
Ensure the successful production of daily batch processing and integrate best practices in computer operator functions.
Ensure and career development to new computer.

Confidential, Nashville, TN

Senior EDI Business Analyst

Responsibilities:

Promoted from ERA Implementation Analyst;
Responsible for expediting and monitoring communication setup and conversions to ensure successful file transmissions for Government and Commercial payers.
Perform electronic claims, Coordination of Benefits (COB) and remittance advice (ERA) testing for professional and institutional transactions to determine what edits are necessary to maintain payer and HIPAA compliance.
Manage and maintain EDI implementation projects to ensure the integrity of electronic claims processing for Commercial and Government payers.
Develop an implementation project plan which provides detailed logic relative to payer specific edits, payer reports, enrollment and testing.
Gathered business requirements and created logic pages and test plans to provide to developers.
Prepare and maintain test data and perform various tests on all EDI maps and prepare all required documents as well as evaluate reports.
Coordinate with EDI trading partners to resolve all production issues and perform transaction tests and resolve all EDI issues according to specification and maintain all transaction sets appropriately.
Defined specifications, determined change and enhancement needs, and oversaw change management procedures, including quality assurance and mapping of all approved changes.
Provide assistance with documentation, special projects, research escalations, new hire and overseas .

Confidential, Nashville, TN

Payer Account Manager

Responsibilities:

Served as the liaison for Commercial and Government vendors to fulfill business and technical requirements as well as provide escalation paths to ensure issues are met and resolved promptly.
Managed payer/vendor accounts, including implementation, end-to-end testing, identification of issues and recommended actions to improve results and working with internal resources to implement system changes to drive improved results.
Cultivated relationships between the vendor and business to ensure effective service and achieve the company’s strategic objectives.
Provided monthly reporting and forecasts to payers/vendor that included claim volume for all lines of business, total revenue and potential business growth opportunities.

Major - Business Management .