PROFESSIONAL SUMMARY

• Welcomes exciting challenges in teh design, development, and integration of advanced technological tools for teh healthcare profession and health services.
• Over a decade of experience dat includes working with over 1,500 payers electronically and over 100,000 physicians.
• Developed and Implemented over 20 HL7 Interfaces
• Familiarity with JCL and CICS knowledge of project management
• Deep knowledge of EDIFACT and BizTalk
• Familiarity with ASC X12 document structures
• Experienced AS400 Cobol Developer 3
• Amisys Cobol Developer 3 Years
• Developed and supported EMR and Practice Management Applications
• Experienced with Pick/Basic over 12 years (Aix, Windows, Linux)
• Experienced Universe DBA and Application Configurations (Aix, Linux, Windows)
• Experienced MYSQL, SQL Server, ORACLE developer
• Developed companion guides for trading partners for 837P 837I and 834
• Experienced in Claim Status Reports from Emdeon

PROFESSIONAL EXPERIENCE

Confidential

EDI ANALYST CONSULTANT

Responsibilities:

• Responsible for teh analysis and design of healthcare X12 maps created on Microsoft BizTalk to an in house mapping engine, a process dat TEMPhas saved Primary Health about $30,000.00 yearly for support and licensing of teh BizTalk Mapper
• Amisys Developerusing Cobol to Maintain and support Applications
• Migrated Amisys Applications to Facets using Data Extractions Methods.
• Extracted data from Amisys to Microsoft SQL for reporting and Archiving
• Gap Analysis of 4010 to 5010 x12 transactions (837, 835, and 834). Familiarity with 270/271 and 276/277.
• Developed 837 Companion Guides for new Trading partners
• Led EDI implementation Meetings with new Trading partners
• Tested validity of transactions using Claredi and Fixed rejected Messages and resubmitted to trading partners.
• Worked as project lead, project manager, and developer on projects
• Remapped 4010 837 professional to NSF file which replaced Microsoft BizTalk Maps
• Remapped 837 Institutional claims to Amisys BCP formats by replacing Microsoft BizTalk Maps
• Implemented a transactional Gateway, replacing teh Microsoft BizTalk application server
• Developed and implemented a routing process for 837 claims to Amisys(NSF), Facets(837), and Teh IPN for reprising sending out 837 and CMS1500 and UB04 paper claims with allowed amounts
• Designed EDI modules/applications with adherence to HIPAA, Claredi certification criteria and industry standards/specifications
• Provided HIPAA integration and applied ANSI ASC X12 standards for 837 (P, me, D), 270/271, 276/277, 278, and 835 transactions
• Provided mapping, gap analysis, and database designs for HIPAA codes sets and EDI transaction processing between IPN(Pacific Source), Clearinghouse, and Payers
• Responsible for loading of ICD - 9CM (Diagnosis Codes), HCPCS (Revenue Codes), and CPT (Procedure Codes) updates

Confidential

LEAD PROGRAMMER / ANALYST CONSULTANT

Responsibilities:

• Acted as lead programmer on teh Trizetto/Facets application for claims processing and provider database, using Sybase database
• Used Access and SQL to produce management style reports and coded using COBOL, CICS, VB 6.0, and UNIX/AIX Shell scripting to automate EDI process
• Worked with data extractions to validate provider information
• Updated provider tables with address and license changes, using COBOL and SQL

Confidential

LEAD EDI ANALYST CONSULTANT

Responsibilities:

• Worked on teh Reverse Engineering Approach project and becamefamiliar with ECMAP and ECGATEWAY from Sybase
• Responsible for software and application implementation
• Developed and supported EDI 837, 837, and HL7 Interface
• Helped design applications for web wrap-around, using UniObjects, Java, and Visual Basic
• Led team to analyze and write technical requirements for transitioning practice management from Universe database to Windows SQL Server database
• Served in teh lead role to incorporate teh Entrinsik Informer Web Reporting tool for IBM U2 family of database products into Universe application and helped enhance teh reporting capabilities of teh application
• Configured ICD-9 codes, HCPCS (Revenue Codes), and CPT (Procedure Codes) media to be loaded into teh application by clients
• Acted as configuration management team lead responsible for daily builds to QA servers and development servers
• Installed Java and Tomcat Web server
• Responsible for installation documentation used by support personnel
• Migrated Clients to Oracle

System Analyst/Programmer

Confidential

Responsibilities:

• Worked on teh TMW Documentation Reverse Engineering Approach project, which included analyzing and writing new requirements
• Played a key role in teh data conversion module and teh upgrading of FORMS application to 9I
• Created teh indexes and provided specifications for teh rollback segments and table space/data files to be used for data and teh index

Confidential

Senior Analyst/Team Lead

Responsibilities:

• Served as project leader for Year 2000 and assimilations for two years
• Spent 60 percent of time during dis period on management activities
• Spent 20 percent of time on actual coding for hospital patient and billing software
• Responsible for mapping EDI X12 and processing 837 and 835 claim detail and payments to more TEMPthan 2000 partners with variations dat required using NEON and BizTalk for mapping and messaging
• Analyzed data formats with more TEMPthan 200 payers to determine EDI requirements and communicated those requirements to programming staff
• Performed QA of EDI before going live with different partners
• Served as a senior business analyst for hospital billing and claims (EDI) applications
• Met with divisional managers and devised a plan of action and weekly summaries of project in MS Excel spread sheets
• Assisted programmers with technical issues
• Analyzed requirements with regional business analysts, gatheird regional exceptions, and ensured coding was complete
• Designed and developed teh client billing (lab billing) documentation for users, administered training, and provided support of teh module
• Worked with clients and teams of programmers to set guidelines for HL7 standards and compliance, including HIPAA requirements
• Led a team to determine programming requirements and communicated directly with clients and in-house business analysts to determine methodology of teh interface programming

Confidential

Senior Programmer Analyst

Responsibilities:

• Supported and DevelopedIn house Applications such as Payroll, Store Productivity and Incentive programs
• Implemented Direct Deposit Application