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Edi Support Specialist Resume

4.00/5 (Submit Your Rating)

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

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