TECHNICAL SKILLS

• Salesforce, Sugar CRM, Emdeon Vision Suite, Emdeon Access, Emdeon 24 - 7, Javelina, Mesa, RedCard, eCW
• Iclinic, Filezilla, UltraEdit, Ultra Compare, PG Admin, eCW 10, MDLand Iclinic 8.0/12.0/12.1/12.2 , Project Management
• Microsoft Visio, Certified in Microsoft Excel/Word/Outlook, Microsoft Power Point, Adobe Editor, Open Office, BIO Web Profile
• Surescripts, Smartsheet, IDX, HCFA-1500, Aetna, UltraEdit, UltraCompare, Benny Central, eClinical Works V10, Windows
• Apple Pages, Keynotes, Conversational Spanish, Microsoft Project, WebEx, Data Ingestion, EDW, Data Migration: State Reporting
• Operational Reporting, Xcelys, PPM CRM, DOOR (Division of Operational Responsibility), DOFR (Division of Financial Responsibility), PBM, E-prescribing

PROFESSIONAL EXPERIENCE

Confidential

Project Manager-ePMO

Responsibilities:

• Works independently on a smaller enterprise project or works within an ePMO project team on a larger enterprise project.
• Provides guidance and leadership to a cross-functional team. Encourages collaboration while holding team members accountable. Builds effective working relationships in an effort to build trust between the Market and ePMO as well as learn the business and technology.
• Provide frequent and effective communication to the project team and management. Responsible for conducting effective Work Stream meetings where the objectives are met and the project is moving forward. Works with the team to identify and resolve issues in a timely manner and escalates when appropriate. Identifies risks and works with the team to create mitigation plans.
• Ensures project deliverables are created, maintained and meet to ePMO departmental standards.
• Perform other duties as assigned.
• Work with BSA on requirements gathering sessions for BRD, FSD, TDD Review
• Work with client directly to ensure requirements are gathered based client/leadership satisfaction.
• Ensure if needed PCR’s are documented approved and logged.
• Work with Project Analyst to Create Weekly Power Point Presentations to showcases statuses on: Project Health Reports, Critical Path Milestones, Governance and Delivery Team Meetings. This would include review, critique and back up for the Analyst, deployment and showcase.

Confidential

Business Analyst/QABA Analyst/Project Manager

Responsibilities:

• UAT testing/claims/providers/patient matching
• Production loading of Providers, Facilities, and Client Network Information
• Fosters ongoing relationship with clients and third party partners
• Suggests areas for improvement in internal processes
• Program and tests correspondence letters for all clients
• Prepares accurate and detailed functional documentation in compliance with SSAE16 guidelines
• Effectively facilitates the release of system upgrades with internal and external users.
• Effectively presents findings to executive leadership
• Identification and recommendations of change requests/enhancements to IT leadership for prioritization.
• Testing for standard coding (CPT, DRG, HCPCS, ICD9/10, place of service) and medical/dental/vision claim formats
• Participate in internal and external meetings for project plan design, strategy and setup
• Collaborate with IT Team, Project Management Team, Operations Team and Executives to insure client needs are met
• EOB programing/design updates and testing in UAT, RedCard and production loads
• Document user testing/review with Management for ID Cards, Correspondence letters/EOBs prior to Production loads
• Assign, track and update user permissions in compliance with SSAE16 guidelines
• Assist with in house IT Audit processes
• Design/Program Client Insurance ID Cards using RedCard Systems/Benny Central
• Manage BRD requests/issues via SmartSheet
• Run Contribution Loads for HRA/Dependent Care/FSA accounts
• CPT Fee Schedule Production loads for clients based on contracts
• 820 File Testing and Review
• Agile Methodologies
• Assist in HCFA claims creation and testing for new onboarding clients
• Breakdown inbound/outbound 834 files to the TRS Specialist and translate findings in layman’s terms to the TRS Specialists so they can reiterate that information to the TRS Business Analyst.
• Create how to guides of 834 files lines, loops, and segments, ID cards, correspondence letter programming, 820 data file conversions, testing and review.
• Test and create user stories for PBM Claims for all lines of business

Confidentia

Client Systems Coordinator/Project Lead

Responsibilities:

• Increase interface certification rate within immunization reporting for more than 930 medical practices
• Lead project collaboration with laboratory companies in connectivity with NYC Providers and Practices;
• Lead projects with Clearinghouses in customized quarterly training events
• Project leader in connectivity between eClinical Works and the City Immunization Registry for the Meaningful Use Incentive Program for Public Health Measures.
• Assisted in troubleshooting technical issues directly with EHR vendors; report issues and sustain maintenance
• Provide expert technical assistance on MDLand software, internal staff and client training.
• Manage the scheduling of on-site and remote appointments for the Revenue Cycle Management Team and decreased the number of outstanding visits by 75%, provide quality assurance reviews and disseminate reports to Senior Management for review; provide logistical support and onsite assistance for the Emdeon/ECW/NYC Regional Extension Center (NYC REACH) clients
• Waterfall Methodologies

Confidential

Project Manager and Trainer

Responsibilities:

• Assisted with new client contracts, Enrolled clients in Claims and ERA service through Emdeon Clearinghouse.
• Opened new client accounts
• See client through onboarding process
• Provided Software training to Clinics; all versions of Iclinic software in person and via WebEx
• Assisted on technical software customer support; billing, claims and troubleshooting
• Troubleshooting; Case Management on Sugar Customer Relationship Management (CRM) system
• Managed claims rejections, enrollment, and Electronic Remittance Advice (ERA), through Emdeon Vision Suite and 24/7
• Resolved Explanation of Benefits (EOB) through Emdeon Vision Suite and 24/7
• Case Management through Surescripts
• Spearheaded client training on how to utilize bi-directional lab interface with the New York City Immunization Registry.
• Assisted staff with multiple enhancement projects for the company relating to new health care reform requirements
• Assist in trouble shooting issues with 837files to comply with Medicaid/Commercial Insurance/Medicare claim guidelines
• Assist in 4010 to 5010 compatibility testing
• Agile Methodologies

Confidential

Medical Biller

Responsibilities:

• Maintained office operations; Patient’s information, income reports; scheduling; report distribution, telephone management and generate bills
• Developed forms, manuals and interoffice procedures
• Processed patients billing, statements, claims reimbursement, and transaction posting
• Managed and responded to queries