KEY STRENGTHS:

• 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.

Technical skills:

• Platform SOFTWARE/SYSTEM
• Mainframe Platform:
• COBOL
• TSO/JCL
• MMIS Recipient
• MMIS Provider
• Edifecs Testing
• MTV
• BADGER
• CAS
• Medisoft
• 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

PROFESSIONAL HISTORY:

Technical/Tester and Software Researcher

Confidential

• 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

Confidential

• 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

Confidential

• 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

Confidential

• 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.