SUMMARY:

• 6+ years of EDI implementation and analysis; where the last 8 months with the former employer dedicated to conducting Health Care EDI transmission analysis (non - standard) as well as monitoring operations of front and backed production processes. During this time, learned and managed several tools to increase the success of communicating our business obligations among other Health Care institutions, allowing us to run a more efficient and strong business relationship with our trading partners.
• Before my last employer, spent close to two years at Daylight Transport, where implemented new business transactions to increase a greater revenue turnaround, such as 210 Motor Carrier Freight Details/Invoice and 820 Payment Order/Remittance Advise. Also, learned and managed several tools such as the Truckmate application.
• Before then, had over 8 years of customer service experience, with the last 4 years dedicated to conducting medical EDI claim analysis and EDI message implementation. During this time, acted as liaison between client area and technical support by planning, conducting, and directing the analysis of problems to be solved with automated procedures that were cost effective. In my later position as a XIFIN Implementation Coordinator, became more proficient with Healthcare EDI standards and formats (HIPAA 4010, 5010 Migration, X12, etc.) where we employed a variety of communication protocols that expose me to the various business process/systems integration (real-time eligibility, ERA, fraud and abuse, worker’s compensation, Web Base portals) solutions.

KEY SKILLS / SKILL LEVELS:

• SQL/ Above Intermediate
• SQL Language Stored Procedures / Above Intermediate
• C++, C#, Java / Intermediate
• BOOMI Integration Solution / Intermediate
• SQLExec / Intermediate
• Microsoft SQL Server Management Studio / Above Intermediate
• SalesForce / Intermediate
• Truckmate / Intermediate
• Helpdesk Management / Intermediate
• Project Management / Intermediate
• Tableau / Above Intermediate
• SSIS and SSRS / Intermediate
• SQL Data warehouse / Intermediate
• MS Visual Studios/ Intermediate

WORK EXPERIENCE:

Confidential, Rancho Cucamonga, CA

Developer

Responsibilities:

• Support the EDI team by building reports in a timely manner to identity gaps and improvement routes in our Claim and Encounter processing methods. SSRS reports that entail high level volume, which have the functionality to drill-through for a more detail view.
• Reconcile the EDI volume by building SSIS packages, SQL Stored Procedures, and SSRS reports to identify the volume of Claims and Encounters adjudicated against the data sent out to the regulatory bodies. Moving into production jobs such as The Manifest Load and Encounter Reconciliation Report automated jobs to name a few.
• Facilitate the processing of the current Claims to Encounter system by building software applications in C# to clean up already processed files and search for EDI 837 files to process.
• Taking part in the BizTalk training to begin helping the development team to improve and maintain the application to adjudicate all EDI Claim and Encounter files.
• Took part in the first wave of training on the new Electronic Data Interchange Management System (EDIMS) for CORE. Spearheading the review process of the business rules implemented to validate the inbound EDI volume. At the same time, bringing into light and training team members on the new database structures and EDIMS application data handling capabilities.
• Built and automated the C# EDI Parser to support and balance the Outbound EDI volume to the regulatory bodies. Ensuring all outbound data transmitted to our trading partners was accounted for and reconciled with the responses received from them.
• Troubleshoot SQL applications currently in production with IEHP. Familiarizing with all our SQL servers, SSIS packages, and SQL stored procedures. Updating some outdated development efforts with new and improved SQL processing practices. Resolving current business user’s needs and troubles they come across.

Confidential, Rancho Cucamonga, CA

Business System Analyst / EDI Coordinator

Responsibilities:

• Support the implementation and ongoing development and testing of electronic transactions, including claims payment processing.
• Support end-user, operations, and management in analyzing business processes/operational data and in developing, designing, and testing system changes based on determined needs.
• Liaison with the provider network for questions and problem resolution of EDI transaction issues. Problems such as EDI rejections and medical claim adjudication concerns.
• Managed and developed reporting dashboards using different feeds such as text files. Monitoring the different lines of service such as the ERA and EFT enrollment process.

Confidential, Santa Ana, CA

EDI Analyst / Business Intelligence / Database and System Analyst

Responsibilities:

• Initially joined the team as an EDI Analyst. Bringing in-house from the offshore team all the EDI ETL workflows (SSIS packages) that processed and managed the trading partner’s enrollment files. SSIS packages were composed of several SQL stored procedures, which I managed and updated to match the business needs.
• Oversaw the TOC automated process by implementing new changes and ensuring all new entries were applied accordingly to our business rules. These TOCs were compared against our database using flags and qualifiers stored in tables and matched using SQL Stored Procedures, Triggers and Functions.
• Administered the internal Aprima (EMR) support service. Ensuring access and roles were successfully implemented in the EMR tool.
• Supervised and Developed other automated services and new automation requests (SSIS). Creating new SQL stored procedures and SSIS packages to download the data from different partners’ sites (FTP, SFTP, Portal).
• Maintained and Administered the Tableau reporting tool. Ensuring the reports in production ran successfully and met the customer’s needs. Also, implemented new dashboards that included Parameters and direct connectivity to our reporting database using the different views the team and I created for our customers.
• Operated all database analytic requests for my department implementing SSRS packages against our SQL database. Using and creating the different tables and views in our database, monitored already in production reports and generated new reports for the upper management in my team.

Confidential, Long Beach, CA

Application Developer

Responsibilities:

• Managed the Gentran EDI tool during the life of the engine by ensuring all EDI transactions were transmitted to our trading partners successfully. Implemented new validation scripts to the EDI maps to accommodate our partner’s needs.
• Migrated our EDI services out of Gentran to the BOOMI solution. During the migration, out of the Gentran tool, I had the opportunity to learn the BOOMI Integration Software. This powerful tool allowed me to migrate over 40 EDI processes to its system and implement an additional 60 new trading partner connections, which initiated my learning experience with SQL Language stored procedures.
• Created and updated several SQL stored procedure to troubleshoot numerous Truckmate failures that limited our ability to communicate with our agents via EDI.
• Worked with the following transaction sets: Load Tender/Pickup Notification (204), Electronic Freight Bills (210), Shipment Status Messages (214), Remittance Advise (820), XML, and Flat File.
• Worked directly in the integration of Intelligent Freight Transportation Systems in our loading/unloading trucking locations. These jobs included BOOMI ETL processes that called several SQL Stored Procedures.

Confidential, San Diego, CA

Implementation Coordinator

Responsibilities:

• Implemented new Customers (Setup Communication types and client testing). Interpreting communication companion guides to coordinate Client Implementations and IT Development to establish secure transaction connectivity for appropriate file delivery meeting our clients’ business needs.
• Delivered administrative support after implementation for billing operations. Also, offered technical support after implementation for healthcare EDI applications in various formats (Print Image, NSF, IMS and ANSI) and communication types (FTP, Web based portal).
• Experience in optimizing the billing operations for some of the nation's largest laboratories. Proactively tracked, interpreted, and implemented payor standards changes within the billing system.
• Familiarity with CPT, ICD-9, HCPCS and other industry publications.
• Work with the following transaction sets: claims (837P, 837I, 837W), ERA (835), Claim Status (266,267), Eligibility (270, 271), HL7 etc.
• Oversaw production environment and prioritize, communicate, resolve and document any Billing and EDI processes or system issues. Translate work processes into business and functional requirements.

Confidential, Orange County, CA

Payer Services/EDI Analyst

Responsibilities:

• Conducted Tier 1 research and analysis (Includes reviewing electronic file acknowledgement human and machine readable reports and resolving file transmission errors).
• Interpreted payer companion guides to coordinate Payer Implementations and IT Development to establish secure transaction connectivity for appropriate file delivery meeting our clients’ and payers’ business needs.
• Worked with the following transaction sets: claims (837P, 837I, 837W), Encounter Data, ERA (835), Claim Status (266,267), Eligibility (270, 271) etc.
• Monitor reports for payers with rejection rates greater than 10% and follow through with corrections
• Oversaw production environment and prioritize, communicate, resolve and document any EDI processes or system issues. Translate work processes into business and functional requirements.
• Analyze the gap analysis requirements for the 5010 Project, testing, migration and implementation of HIPAA 4010A1 to 5010 compliances.