Contract Consultant Resume

OBJECTIVE:

Leverage my healthcare EDI experience and application development background in a role as a Healthcare EDI Analyst, Business Analyst or Project Manager to drive the quality, accuracy and timely response to changes in the healthcare industry.

SUMMARY:

Expert level knowledge of healthcare industry applications and processing, ANSI x 12 820 , 834, 835, 837, 270/271, 276/277 transactions, HL7, NCPDP and XML formats.
Experienced as a team leader, project coordinator, business / data analyst and client services support specialist.
Skilled in project management, SDLC tools and methodologies, requirements definition, documentation of functional and technical specifications.
Proven ability to develop positive relationships though team - building and mentoring junior staff.
Over 25 years of Information Technology systems development, design and testing.

PROFESSIONAL EXPERIENCE:

Confidential

Contract Consultant

Responsibilities:

Determined end-user requirements and implemented Edifecs based solutions for new business lines, enabling acceptance and delivery of ANSI 834 and 82 0 using SpecBuilder version 8.3 for mapping
Guidelines and severity files. Developed Transact SQL procedures used to update Facets based Enrollment tables.

Confidential

EDI Analyst / Consultant

Responsibilities:

Transformed complex legacy data structures into standardized ANSI files.
Replaced WTX based system using new Edifecs routes, maps and guidelines to support State of New Mexico’s new Centennial Encounters.

Confidential

Contract Consultant / SME

Responsibilities:

Served as project coordinator and subject matter expert on ANSI 277 transaction set posting into HealthConnect claims system.
Coordinated with Patient Financial Services process owners, internal payers and RelayHealth clearinghouse on Revenue Cycle Management enhancements.
Responsible for mapping inbound status data to assigned work queues.

Confidential

Software and Implementation Consultant

Responsibilities:

Developed and implemented solutions for key healthcare clients.
Responsible for analysis, design, coding and testing of Edifecs software. Products used include SpecBuilder, MapBuilder, JavaScripts, XEngine and TPM.
Projects include version 40 10 to 501 0 step-up / step-down for ANSI transactions 835, 837, 270/271, 276/ 277 and 99 9.
Other projects required development of custom validation guidelines and data conversions of ANSI files to XML, NCPDP, Cobol Copybook or other proprietary data formats. Skilled in Edifecs versions 6.8, 7.x and ETL, TM, XES, EAM components.

Confidential

Sr. Production / Research Analyst

Responsibilities:

Coordinated efforts between payers, vendors and internal development departments to resolve errors with inbound 835 ERA files. Corrected inbound 835 ERA data to pass SNIP levels 1 and 2 validation and created scripts to repair simple formatting errors.
Monitored various run-time processing points and performed root-cause analysis for resolution and client notification.
Supported providers and vendors by serving as second-tier client services support for difficult issues with inbound claims in 837, NSF or HCFA1500 formats.
Organized data requirements and definitions for v4010 to v5010 migration project.
Created educational presentations and presented internal courses on 997 file format and data, 837 file format, looping structure and data requirements. Mentored junior staff as needed as the HIPAA compliance subject matter expert.
Solid knowledge of 837 Claims, 835 Electronic Remittance Advice, 997/999 File Acknowledgment, 270/271 Eligibility and 276/277 Claim Status Inquiry formats.

Previous Career Experience

Prior to my service at Capario, I served as a programmer / analyst or contract consultant in software development, systems analysis and project leadership primarily for healthcare, insurance, manufacturing and human resources applications.
My focus was primarily on HP/3000 and client / server platforms using COBOL, Image, V-plus and Powerhouse application developer.

Confidential

Contract Programmer

Responsibilities:

I successfully led project teams for Y2K compliance and updates, legacy systems to Oracle migration, new applications design, development, testing and implementation.
I programmed enhancements to existing applications in Human Resources, healthcare, insurance, manufacturing, payroll and corporate accounting systems.
Created functional enhancements and reporting capabilities for a Made-2-Manage manufacturing application using Visual FoxPro MS-SQL and Excel.

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