SUMMARY:

• Over fifteen years of increasing responsibility in the area of technical support and business analysis, with demonstrated proficiency in the following key areas:
• ANSI 4010 HIPAA 837 all formats
• EDI Specialist (Electronic Data Interchange)
• Help Desk/Customer Relations
• Supervisory Skills/Team Leadership
• Business Processes/Needs Analysis
• Hardware/Software Support &
• Some knowledge of HTML,SQL and VB
• Mainframe operations

TECHNICAL SKILLS:

Hardware/ Operating Systems: Installation, troubleshooting, and configuration of hard drives, modems, sound cards, printers, memory, CD - ROM s, floppy drives and peripherals on IBM compatible systems.

Languages/ Databases: Microsoft Access, MS Excel, MS DOS, HTML, IBM OS-390 JCL, MS Word, ANSI 4010,5010 and all HIPAA transactions

Tools: TSO/ISPF, FTP, PC Anywhere and Carbon Copy.

PC: Windows; HTML, MS Office, MS Works, MS Money, MS DOS, Macintosh, Website Design

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst II

Environment: MS Access, MS Excel, MS Project, HIPAA, FTP pro, AS400, TSOA, IMSP, Visual basic scripts

Responsibilities:

• verify accuracy of X12 HIPAA transactions, 837,834,270,271,276,277 etc
• Risk Adjustment Data
• EDI Specialist
• Verify provider and claim information in WGS 2.0 and Star
• Using Filenet verify claim information
• Process 837 test files
• Analyze 837 test data from providers
• Run test files through Claredi
• Instruct providers on 837 P & I formats and Claredi errors
• Gather user requirements, make reccomendations for system changes.
• Come up with business solutions to satify HIPAA requirements.
• Verify HIPPA production files for providers
• Keep up on CMS changes and alert the appropiate staff.
• Process enrollments for 837 claims and ERA/EFT.
• Validate provider information in the mainframe to process enrollments
• Assist providers in a helpdesk environment with claims and X12 formats
• Create monthly encounter report
• Track encounter counts
• Knowledge of Enterprise gateway

Confidential

Mis Support Analyst

Environment: MHC, Ms excel, HIPAA, MS Access, Claredi, UB92, NSF,EC map, FTP Pro

Responsibilities:

• Create HIPAA transaction companion guides and verify accuracy X12 HIPAA transactions
• Process 837, 837,834,270,271,276,277 etc production files
• Risk Adjustment Data
• EDI SPECIALIST
• Analyze 837 test data from providers
• Run test files through Claredi
• Instruct providers on 837 P & I formats and Claredi errors
• Gather user requirements, make reccomendations for system changes.
• Process files using EC map to translate into a flat file that I can upload into MHC our billing software.
• Analyze MHC problems and create solutions.
• Come up with business solutions to satify HIPAA requirements.
• Process 834 monthly production files
• Create and process 837 test data to AHCCCS
• Create memos to inform staff of HIPAA updates.
• ICE team member HIPAA task force.
• Lead on ICE encryption team/
• Keep up on CMS changes and alert the appropiate staff.

Confidential

System analyst

Environment: EZ cap, MS Access, MS Excel, MS Project, Crystal reports, HIPAA, FTP pro

Responsibilities:

• Responsible for all encounter submissions to Health Plans and tracking.
• Analyze HIPAA version of EZ Cap and make recommendations to software vendor and test updated recommendations.
• Automate the system and data process.
• Risk Adjustment Data
• EDI Specialist
• HIPAA testing of all in/outbound transactions.
• Communicate with Health plans to get specifications and preferred method of data submission.
• Discovered system errors and report them to system programmers to be corrected.
• Track errors and make sure that departments responsible make correction so that I can resubmit data, including verifying that correct ICD-9 and HPCS and CPT codes are being used.
• Constantly checking Medi-Cal and other sites for currents changes and inform the appropriate departments so that changes can be made.
• Create reports using Crystal and Arpeggio reports.
• Using Access and Crystal reports to verify that all data that should be sent is being sent to Health plans.
• Extract data using Crystal reports.
• Discovered system errors and correct them.
• Communicate with the health plans and clearinghouses to decrease errors and increase volumes.
• Track encounters, verify error reports and instruct Medical Groups on corrective actions.
• Created an organized working area and department.
• Attend JOC meetings to discuss compliance issues and other pending items.
• Use MS Project to better organize my time.
• Test, analyzed and submit new file formats
• Create queries, reports and research data using MS Access, MS Excel., and Crystal reports.
• Validate enrollment for data processing.

Confidential

Senior Business Operations Analyst II

Environment: MS Access, MS Excel, MS Project, Crystal reports, HIPAA, FTP pro, AS400, TSOA, IMSP, Visual basic scripts

Responsibilities:

• ANSI HIPAA 4010 testing for all formats.
• Knowledgeable in X12 all formats and legacy formats.
• EDI Specialist
• Responsible for providing updates to system tables related to claims, e.g. diagnostic code, procedure code, code sets for claim status, (from the Washington publishing site), modifier code, and pricing tables.
• Comprehensive knowledge of professional (1500) and institutional (UB92) billing forms, knowledge of CPT, HCPCS and ICD9 codes.
• Analyze information and situations to determine possible future issues and report resolutions and recommendations to the team for solutions.
• Verified accuracy of all claims using TSOA IMSP and FILEAID on AS400
• Processed enrollments for Professional and instructional claims, eligibility, and encounters.
• Ability to work both independently and in team-oriented environment
• Track claims and encounters, verify error reports and instruct Medical Groups on corrective actions.
• Created month end reports and database to track data.

Confidential

Senior Business Operations Analyst

Environment: MS Access, MS Excel, MS Project, Crystal reports, HIPAA, FTP pro, AS400, TSOA, IMSP, Visual basic scripts

Responsibilities:

• Created Access database to effectively track all claims, contracts and calls. Created reports and queries as requested.
• EDI Specialist
• Supported external customers with troubleshooting system problems and applying appropriate solutions. Removed software from provider’s systems using PC Anywhere and Carbon Copy prior to license expiration
• Supported internal employees with installation and configuration of software.
• Ensured department wide operation of MS Outlook, including making necessary configuration using MS exchange server. Added required configurations to Outlook allowing administrative personal access to management’s calendars.
• Provided installation and ongoing support of software and hardware, printer configuration, etc. for employees.
• Trained employees on various software packages including MS Office, Windows navigation and answered how to questions.
• Transmitted claims via modem, helped to setup a FTP server.
• Implemented and automated procedures that resulted in 80% increased efficiency in the tracking and processing of all Medi-Cal and Medicare Part B claims and Medi-Cal contracts.
• Authored procedures on all desktop duties.

Confidential

Technical Support Specialist

Environment: MS Access, MS Excel, MS Project, FTP pro, HTML

Responsibilities:

• Resolved customer issues with hardware; CD-ROMs, soundcards, Ethernet cards, printers and software.
• Created a database application to track all customer calls. Which resulted in faster access to data, counts and numerous reports could be made.
• Designed and implemented time saving forms to address routine service procedures.
• Arranged equipment exchanges making sure that the configurations were correct.

Confidential

Technical Support Manager

Environment: MS Access, MS Excel, FTP pro, Windows and Mac

Responsibilities:

• Provided Help Desk support, handling over 60 calls per day, to effectively troubleshoot hardware and software problems.
• Wrote procedures; updated and researched troubleshooting manuals. Beta-tested all new software products on Windows 3.1, 95 and Macintosh; wrote detailed reports for the correction of identified software problems prior to public release.
• Supervised the Technical Support Department.

Confidential

Hardware/Software Technical Support Lead

Environment: MS Access, MS Excel, Windows

Responsibilities:

• Provided Help Desk support for customers with hardware and software problems.
• Created and was in charge of the Data Acquisition Team (DAT) which was responsible for tracking all incoming customer calls, faxes and written correspondence. Wrote all relevant procedures and conducted for the team.
• Assisted in departmental of Microsoft software, including Windows, Excel and MS Word.
• Developed strong hardware and software troubleshooting skills