EDI Consultant/Manager Resume

SUMMARY:

I am a highly skilled IT professional with over twenty three years experience.
I have expertise as an EDI Specialist in various industries including healthcare and retail.
I was the project manager for the implementation of SAP Apparel and Footwear (from an overwhelmed off the shelf package) with EDI while at Confidential .
I have excellent communications skills; both written and verbal, and work independently as well as in a team environment.

TECHNICAL SKILLS:

SQL, ANSI, XML, Pick Basic, Ultimate Basic, Unidata, Facets, SAP - AFW, Comtec, Toad for Oracle/SQL, Crystal Reports, Gentran NT, Microsoft Office suite, Visio, Encryption software, AS2, FTP, Van Communication, Windows NT, Oracle, Ultra Edit, among many other programs and utilities. I have specialized in transition from COTS (Commercial Off the Shelf Software) to large ERP applications.

PROFESSIONAL EXPERIENCE:

Confidential

EDI Consultant/Manager

Responsibilities:

Provided the company with an EDI solution for the import and export of Medicare claims, enrollment information, claim status, and eligibility to meet HIPAA standards i.e., (834,835,837,270,271,276, 277); working closely with the CMS guidelines.
Developed the integration of the Trizetto claims system and Gentran Server for Windows utilizing existing staff and various consultants. As part of the integration process, provided in depth data/gap analysis documentation in order to ensure all necessary elements were available to create HIPAA compliant Ansi X12 documents for version 5010.
Performed testing between multiple clearinghouses to ensure the transition was smooth and transparent to the end user. In order to accomplish this, extensive QA was performed with the various departments receiving the data; assuring the accuracy and quality of the information they received. Many test scenarios (scripts) were developed to ensure a smooth transition to electronic receipt and delivery of the EDI data. Several of the documents required immediate turn-around (real time) to achieve the response time required by the HIPAA requirements.
Integrated the EDI data into various disparate existing systems which was accomplished via the QA testing process and the sign off by the lead tester of the end user group.

Confidential

EDI Specialist/Manager

Responsibilities:

Implemented SAP Apparel and Footwear ERP system with EDI, using ODBC connections to an Oracle database, documenting that all data elements from the SAP IDOCS were present to build the X12, XML, EDIFACS data sets. Quality of data was paramount to the success of the implementation.
Developed a sophisticated EDI platform utilizing Gentran for Windows.
Brought Confidential from a two customer outsourced EDI program to more than 50 customers in-house.
Introduced Confidential to AS2 technology to minimize van costs, as well as FTP. Each document sent and received was done so by automating the processes via scheduling.

Confidential

EDI Manager

Responsibilities:

Implemented all of the EDI HIPAA related X12 version 4010A documents to bring them up to compliance with the new laws.
Relationships were established with multiple Clearinghouses / Insurers/ Payers in order to process as many claims as possible (daily), as Confidential was primarily a third party administrator.
I provided intensive data analysis, QA, test scripts, documentation, and collaboration with other IT resources and business units. This was imperative in order to successfully trade with multiple Clearinghouses/Payers. Integration of the EDI documents had to be accepted by various in-house software platforms that Confidential utilized.
Confidential was one of the first Blue Cross affiliates to become HIPAA compliant with EDI.

Confidential

EDI Specialist

Responsibilities:

The majority of the EDI implementation was financial based. Set up direct deposit with many banks using the Confidential clearing house. The EDI platform at IHS coordinated all vendor payments, direct deposit for more than 600 post acute care facilities across the United States.
Created automated processes to send issuance, receive reconciliation with positive pay capabilities. We also provided our treasury workstation with other financial data such as BAI (bank reporting).
Implemented PeopleSoft Financials and Human Resources to be integrated with EDI via Gentran for Windows.
Worked with a variety of IT and business associates to determine the data elements provided by PeopleSoft matched the required data to build the X12 documents by developing QA scripts, charts, spreadsheets, and Visio documents to reference the gaps.
All processes were automated using the Tivoli Maestreo scheduling software, which moved data from PeopleSoft to Gentran.

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