Edi Support Specialist Resume
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Rancho Cordova, CA
SUMMARY:
To obtain a challenging and rewarding position that will benefit from my background and training.
SKILLS:
- Microsoft Office Suite EMR/Data Storage
- 10 - key 10,000 ksph Medical Records (EMR)
- Typing 45-50 wpm Professional Communications
- Alpha/Numerical filing Medical Office Procedure
- ICD-9/CPT/HCPCS Coding HIPAA Compliance
- Data Entry Tricare Insurance
- Referral/authorizations Data Entry
- Medical Terminology
EXPERIENCE:
EDI support specialist
Confidential, Rancho Cordova, CA
Responsibilities:
- Maintain multiple Email boxes
- Handles migration, PGP keys, FTP. FTPS, SFTP and transmission information from carriers
- Coordinate and follow up on projects
- Read and map account structures from carriers to Confidential system
- Assisting with updating EDI feeds (feed Modifications)
- Understand and knowledge of some cold fusion coding
- Ability to meet deadlines
- Research, resolve and answer technical issues with EDI files
- Completing EDI rollovers for multiple groups
- Managing and checking daily scheduler logs of all EDI files
EDI anaylst
Confidential, El Dorado Hills, CA
Responsibilities:
- Ensures quality assurance and HIPAA standards are followed
- Multi-task between multiple screens
- Initiate correspondence between clients and trading partners
- Researching benefit membership
- Proficient in HIPAA EDI 5010 transaction code sets (834)
- Maintaining relationships between clients and trading partners
- Provides on-going training and customer service support to new employees
- Provides analysis, support and guidance to external customers on simple to moderately complex electronic data transfers covering; enrollment, claims, billing statements and payments
- Identifies potential problems and defines user requirements, and user authorization protocols
- Conduct data transfer, testing and reviews submissions for accuracy; troubleshoots transmission errors
- Provide assistances to large, small partners/employers upon request on standard or routine electronic data transmission problems, issues and questions (i.e., electronic exchange of data including enrollment and claims)
- Improve accuracy leading to decreases costs and greater ease of conducting business with BSC
Claims support coordinator
Confidential, El Dorado Hills, CA
Responsibilities:
- Prep Hospital claims for further review
- Verifying UB04's, EOB & Itemization's BSC policies and procedures
- Multi-task between multiple screens
- Check for previous cases regarding same patient
- Entering patient claims into the system
Intake representative
Confidential, Rancho Cordova, CA
Responsibilities:
- Processing referrals and authorizations
- Multi-task between multiple screens
- Knowledge of Tricare policies and procedures
- Searching for eligible providers
- Updating patient information
- Eligibility checks
