- A good oral and written communicator with skills and patience to work with off-shore staff
- An aggressive IT professional with excellent problem solving and research skills.
- A self starter, team player who enjoys challenges and meeting deadlines early.
- B/A Lead for Offshore Contractors.
- Excellent oral and written communication and interpersonal skills. Ability to communicate effectively through a variety of media to individuals or groups in a manner that engages the audience and helps them to understand and retain the message.
- Technical understanding of the federal certification and accreditation life safety and physical environment standards for hospitals, including OSHA, and CMS.
- Interpret technical issues and provide recommendations to management.
- Ability to organize and prioritize work to meet job demands.
- Strong decision-making identifies and understands issues, problems and opportunities compares data from different sources to draw conclusions. Uses effective approaches for choosing a course of action or developing appropriate solution. Takes action that is consistent with available facts, constraints and probable consequences.
- Ability to develop and use collaborative relationships among team and departments to facilitate the accomplishment of work goals.
- Ability to supervisor/train for enhanced skill development.
- Platform SOFTWARE/SYSTEM
- Mainframe Platform:
- MMIS Recipient
- MMIS Provider
- Edifecs Testing
- Web Platform:
- BILLING/ENROLLMENT System:
- Company Group Benefit setup, maintenance and Customer Service administration
- Infra ES Operations
- Enrollment Systems Dashboard
- PC Software:
- MS WORD
- MS EXCEL
- MS ACCESS
- MS PowerPoint
- MS Visio
- XQMF SQL
Technical/Tester and Software Researcher
- Work with End-User to created and organized Memorandum of Understanding MOU in regards to testing and implementation accuracy.
- Provide testing online screen completed by programmers.
- Create test criteria to ensure online edits were working properly.
- Document pass or fail results for sign-off or retesting.
- Generate reports via batch Job submission for test results review.
- Document batch and online problems found during testing.
- Created documentation for out-of-scope changes found during testing.
- Assisted providers with EDI transaction testing using EDIFECs.
- Worked with BIZ-Talk developers to derive the applicable EDI transaction Companion Guide.
- Worked on ICD-10CM and ICD-10 PCS development design based on overall concept.
- Developed overlapping codes between ICD-9 and ICD-10 documentation.
- Worked on backward and forward mapping strategies between ICD9 and ICD10 to be used by developers and testers.
- Analyzed and test the MMIS Provider Enrollment/payment process.
- Reviewed current system write-ups and new system rules to ensure that all areas were included and data discrepancies were known.
- Created 4010 companion guides and data cross-walks required for the following X12 transactions: EDI: 820 834 837-I 837-D, 837-P.
- Worked with the programming staff to reconcile required data fields and the compliance EDI X12 820 and 834 fields as well as required mainframe processing fields.
- Created test results using SQL data retrieval using XQMF database.
Billing and Enrollment Specialist/Customer Service
- Implement and build web enrollment pages for groups who have contracted with Humana using a documented process.
- Participated in conference calls with groups and Humana Associates to plan the group web implementation.
- Perform testing of system enhancements to ensure all processes performed correctly.
- Send correspondence to beneficiary pertaining to incomplete applications, capacity issues, selection choices and other discrepancies as needed.
- Special assignments, investigations, and other duties as requested by management.
- Responsible for ensuring that customers had a positive web experience when resolving customer errors.
- Coordinate with multiple departments to resolve the errors as one of the top error resolution producers on the project.
Human Resources Manager
- Organize and prioritize work to meet job demands.
- Maintain a good working relationship with peers, superiors and subordinates while working under stressful or emergency situations.
- Supervised /train for enhanced skill development.
- Prepare new hire documentation.
- File proper documents
- Provided aid to employees in matters involving their work performance
- Prepared documents that evaluate each employee's performance.
Skilled Labor/Forklift Driver
- Responsible for making concrete an mortar for commercial and residential projects.
- Building scaffold.
- Setting up brick and cmu for masons.
- Driving Forklift to distribute masonry materials to masons.
- Ability to lift 75lbs or more.