OBJECTIVE:

To obtain a leader administrative position in the allied health field where I can utilize my technical skills.

TECHNICAL SKILLS:

• Contract Interpretation
• Medical Terminology
• Medical and Dental Claims Examining
• ICD - 9-10 Coding
• CPT Coding
• UB-92/CMS 1500
• VB Scripts (Visual Basics) Mapping
• Reading and Understanding EOB (ERA)
• HIPAA Guidelines
• Typing (75 wpm)/Data Entry
• 10-Key
• EDI ANSI 4010-5010/Citrix software
• Med iSOFT
• Commercial/Government Ins. (HMO/PPO)
• UBH /PBH Trizetto Facets
• PBAR/PAS /ACE/FIRE Systems
• Customer Service/Call Center
• Eligibility/Credentialing Verification
• Salesforce /Microsoft HRIS systems
• Access DB/ Microsoft Sql/iCES
• Excel

PROFESSIONAL EXPERIENCE:

Confidential, Remote MN, CA

Sr IT Sys Analyst

Responsibilities:

• Build and implement simple to complex claim editing logic in support of internal payment policies
• Act as a thought leader/ SME in the design and implementation of claim editing logic
• Develop architecturally sound editing rules for complex business requests using iCES, Standalone Citrix based systems.
• Used Excel to Document of customer business processes, workflows and requirements as they relate to the issues identified by a development initiative.
• Assured appropriate unit testing coverage
• Review and contribute to overall QC/QA of test plans.
• Participated in project teams with both internal and external customer (s) to assure high quality through management of ongoing processes.
• Assisted in troubleshooting of technical issues as identified.
• Worked collaboratively with all key team members

Confidential, Orange, CA

Sr. Business Analyst

Responsibilities:

• Evaluate, design, test, implement and upgrade rule edits for clearinghouses and Confidential to ensure proper delivery of claims with less errors.
• Supports Run and Maintains reports for the direct manager and claims managers daily.
• Utilizes (minimal) VB Scripts, Query, Access, excel and pivot tables to run data statistics on Error Code trends, tracking of all inbound claims and Maintain Imagenet DB for claims examiners.
• Developed Databases to ensure efficiency in reporting tracking of inbound claims and error codes and error trends.
• Manages and correlates rule edit research with direct manager, EDI and clearinghouses.
• Functions as a liaison between the provider, the clearinghouse and our EDI and claims department for various issues.

Confidential, Anaheim, CA

QA Applications Analyst

Responsibilities:

• Evaluate, design, test, implement and upgrade rule edits for front-end Hospital patient access registration purposes.
• Supports and Maintains reports for QA coordinators daily.
• Utilizes VB Scripts, Showcase Query, Access, excel and pivot tables to run data statistics on usage, percentages for rule edits feasibility.
• Utilize ACE, PBAR and Patient Access systems for rule research and rule testing.
• Run Calibration, Daily and Compliance reports during mid-month and month-end with FIRE (Auditlogix) systems for QA coordinators and upper management.
• Manages and correlates rule edit research with managers, senor analysts, business clients and vendors on a weekly team meeting basis.
• Functions as a liaison between end-user, other analysts and software developer.

Confidential, Ontario, CA

Junior EDI Analyst

Responsibilities:

• Develops technical specifications for EDI application interfaces using EZEDI/and IDX medical software.
• Provides technical support during and after implementation of healthcare EDI applications and updated transaction formats.
• Responds to EDI inquiries and issues, trading partners and vendors regarding healthcare transactions (enrollment, claims, encounter, status, payments) and clearinghouse activities.
• Conducts various analyses of EDI transactions and formats and is responsible for format mappings, processing procedures and other EDI documentation as well as various EDI reporting.
• Provides and communicates local expertise regarding standard concepts, practices and procedures of EDI formats (proprietary, NSF, ANSI, HIPAA)
• Communicate with IPA, IPO, Payers and Providers weekly on updated EDI claims configuration.
• Meeting weekly and monthly deadlines for encounter filing on capitated claims reimbursements.
• Work closely with software vendors for system updates such as new segments applied.
• Implemented the software updates by testing in UAT and applying the updates to production.
• Functions as a liaison between end-user, other analysts and software developer.

Confidential, Santa Ana, CA

EDI Enrollment Specialist

Responsibilities:

• Called Payers to Check on Status of 835/837/237 Claims Set up status.
• Coordinated and facilitated training on the Kareo software for clients, providers and upper management.
• Assigned Clients, Vendors and Business Partners to help w/EDI transmission and set up account.
• Used Phoenix, ANSI, Salesforce, DOS and Internal portal systems to check claim status /submit.
• Appealed claims for coding and erroneous denials.
• Handled outbound/inbound calls from vendors, customers, trading-partners and payers daily.

Confidential, Costa Mesa

Sr. Data Entry Clerk/ Providers Operation Coordinator

Responsibilities:

• Manage Providers Information using UBH and PBH Facets.
• Input Demographics, Fee Charges, and Credentialing Dates for Providers.
• Check eligibility for providers EDI for reporting purposes using CAQH and maintaining Databases