Member Clinical Staff - Program Facilitator Resume Los Angeles, CA - Hire IT People

SUMMARY:

Expert level knowledge of healthcare industry applications and processing, ANSIx12 820, 834, 835, 837, 270/271, 276/277 transactions, HL7, NCPDP and XML formats. Excellent with Confidential Transaction mapping, data validation, error handling, XEngine.
Experienced as a team leader, project coordinator, business / data analyst and client services support specialist.
Skilled in project management, SDLC tools and methodologies, requirements gathering and definition, documentation of functional and technical specifications.
Proven ability to develop positive relationships though team - building and mentoring junior staff.
30 years of experience in Healthcare, Insurance, Human Resources, Manufacturing, Corporate accounting, Payroll and Franchised business Information Technology systems design, specification, development, implementation and testing.

PROFESSIONAL EXPERIENCE:

Confidential, Los Angeles, CA

Member Clinical Staff - Program Facilitator

Responsibilities:

Functioning as first line supervision of inpatient residents for compliance with program rules and attendance.
Perform random and as necessary drug testing. Implement and ensure management policies and procedures are followed.
Document resident progress notes and unusal occurrances.
Provide for residential and property security and regularly monitor new inpatient vital statistics.

Confidential, Nashville, TN

Responsibilities:

Working remotely I developed specifications, documentation, and file transform maps in Confidential to convert ANSI x12 837P, D, and I formats to WPC proprietary XML structures for processing.

Confidential

EDI Business Analyst

Responsibilities:

Determined end-user requirements and implemented Confidential based solutions for new business lines, enabling acceptance and delivery of ANSI X12 834 and 820 using SpecBuilder version 8.3 for mapping, guidelines and severity files.
Developed Transact SQL procedures used to update Facets based Enrollment tables.
Created business rules and edit specifications documents to correct and/or reject inbound 837 files prior to loading into Facets.

Confidential

EDI Analyst / Consultant

Responsibilities:

Transformed complex legacy data structures into standardized ANSI x12 files.
Replaced WTX based system using new Confidential routes, maps and guidelines to support Confidential ’s new Centennial Encounters.

Confidential

Contract Consultant / Project Specialist

Responsibilities:

Served as project coordinator and subject matter expert on ANSI x12 277 transaction set posting into Confidential claims system.
Coordinated with Patient Financial Services process owners, internal payers and Confidential clearinghouse on Revenue Cycle Management enhancements.
Responsible for mapping inbound status data to assigned work queues.

Confidential

Software and Implementation Consultant

Responsibilities:

Developed and implemented solutions for key healthcare clients.
Responsible for analysis, design, coding and testing of Confidential software.
Other projects required development of custom validation guidelines and data conversions of ANSI files to XML, NCPDP, Cobol Copybook or other proprietary data formats.
Skilled in Confidential versions 6.8, 7.x and ETL, TM, XES, EAM components.

Confidential, Santa Ana, CA

Sr. Production / Research Analyst

Responsibilities:

Coordinated efforts between payers, vendors and internal development departments to resolve errors with inbound 835 ERA files.
Corrected inbound 835 ERA data to pass SNIP levels 1 and 2 validation and created scripts to repair simple formatting errors.
Monitored various run-time processing points and performed root-cause analysis for resolution and client notification.
Supported providers and vendors by serving as second-tier client services support for difficult issues with inbound claims in 837, NSF or HCFA1500 formats.
Organized data requirements and definitions for v 10 migration project.
Created al presentations and presented internal courses on 997 file format and data, 837 file format, looping structure and data requirements. Mentored junior staff as needed as the HIPAA compliance subject matter expert.
Solid knowledge of 837 Claims, 835 Electronic Remittance Advice, 997/999 File Acknowledgment, 270/271 Eligibility and 276/277 Claim Status Inquiry formats.