TECHNICAL SKILLS:

Adept in the following skills:

• Microsoft SQL Server 2008/2012
• SSIS and SQL Agent Job Automation
• Oracle SQL 11g
• Crystal Reports
• Intermediate level Microsoft Office Suite(Word, Visio, Excel, Access and Power Point)
• CS6 Dreamweaver
• Java Script and HTML CSS
• Agile SDLC
• Windows Power Shell
• ANSI X12 EDI Transactions

PROFESSIONAL EXPERIENCE:

Confidential, Westmont, IL

Electronic Data Interchange (EDI) Analyst

Responsibilities:

• Provide analysis and audits of operational data, identify trends and recommend operational solutions related to EDI.
• 837 Claim file routing, uploading and processing in EZCAP.
• Error correction on 837 claim files. Generates outbound Acknowledgement files. 835 and WCEDI response letters.
• Develop and test system changes to meet determined needs.
• Creates SQL Views for reports and agent jobs.
• Perform ETL processes and create stored procedures via SQL Server.
• Creates simple Stored Procedures for Process Automation.
• Implementation and analysis of Power MHS system functions associated with electronic transaction processing.
• Work with outside areas to understand business issues and coordinate resolutions through documenting workflows for resolution, or extracting reports to satisfy the business requirements.
• Communicate with technical resources and EDI submitters to facilitate testing and problem resolution process.
• Develop and implement communication and marketing strategy with Provider Relations to enhance volume and quality of EDI submissions.
• Aid in designing documents to facilitate provider understanding of EDI requirements.
• Proficiency in use of Quality reporting databases.

Confidential, Downers Grove, IL

Systems Analyst

Responsibilities:

• Performs agency quality assurance activities and ensure completeness of clinical records.
• Reviews daily documentation of assigned field staff, including admissions, resumptions of care, re - certifications, interim orders, daily progress notes and discharges.
• Facilitates transmittal of claims 322, 329 from point A to point B.
• Audits UB92s and HCFA
• Reviews UB-92 versus documentation to troubleshoot ADRs.
• Holds individual sessions with assigned field staff regarding coordination of services and documentation.
• Performs data collection activities and related data analysis for quality improvement.
• Assists in Agency’s overall quality improvement, OBQI report.
• Analyzes and interprets business requirements to technical specifications from a business stance to determine how the user will utilize the system.
• Analyzes existing applications systems and programming logic problems and, where necessary, revise the logic and procedures.
• Designs and writes programs in accordance with client specifications.
• Performs unit tests and final analysis on test results of projects before release to Quality Assurance testing.
• Produces and maintains program documentation.
• Writes technical specifications for Associate, Programming/Analysis, as required.
• Analyzes and provides corrective action for program problems and establish orderly maintenance procedures for systems.
• Investigates and researches system environments (i.e., reporting systems, switching systems, computer systems, etc.) to assist in resolving existing program problems or identifies solutions to new business requirements.
• Prepares charts, tables and diagrams to assist in analyzing problems and new business opportunities.

Confidential, Warrenville, IL

Clinical Quality Assurance

Responsibilities:

• Evaluates all clinical documentation on patient's charts in conformance to quality compliance to HIPAA and Medicare standards.
• Recommends ideas in planning and assisting in the implementation of action of Outcome- Based Quality Improvement (OBQI) initiation of the agency
• Report results of evaluations to appropriate Quality/Operations stakeholders.

Confidential, Skokie, IL

Clinical QA Team Lead

Responsibilities:

• Standardization of work-systems and procedures: initiates the establishment of standards among the assistants through participative problem-solving and consensus-building.
• Improvement of intra-group communication and inter-personal relations: facilitates sharing of insights and best-practices within the team.
• Goal-setting: facilitates both individual and collective work-planning among the members of the group (on a daily and periodic basis).
• Monitoring and support of productivity enhancement efforts: provides assistance to team assistants individually and to the whole group towards higher levels of effectiveness and efficiency.
• Representation of the team: presents individual and collective concerns to the Director of QA and/or to management, proposes initiatives and actions aimed at work-improvement to the concerned parties.
• Recommends ideas in planning and assisting in the implementation of action of Outcome- Based Quality Improvement (OBQI) initiation of the agency.

Confidential

Quality Evaluator

Responsibilities:

• Evaluates end-user transactions i.e. telephone calls for accuracy and conformance to Quality standards set by client
• Report results of evaluations to appropriate Quality/Operations stakeholders (Team Coaches and Account Management) on a daily, weekly and monthly basis.
• Achieves departmental productivity requirements (e.g. number of calls monitored per month on schedule).
• Participates in internal quality audits (e.g. periodic audits of all key customer related processes to determine process control and efficiencies) and recommend changes.
• Demonstrates mastery and comprehension of client’s quality standards.