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EDI Specialist

EDI Specialist

Milwaukee, WI

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Work Experience

EDI Specialist

Kohler's
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Sheboygan, WI
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September 2011 to September 2011

Respond to failed incoming or outgoing EDI document emails from Systems. 
❑ Address EDI 824 or 864 invoice or ASN rejection notices. 
❑ Correct and have Systems retransmit rejected invoices, ASN's, etc. 
❑ Respond to various Customer Service inquiries or requests (e.g., analyze EDI PO and determine what customer needs to do to order correctly). 
❑ Respond to various customer inquiries or requests (e.g., missing ASN). 
❑ Screen SAP setup emails from Kathy Bowe and Gail Byrd and submit EDI setup requests to Systems, as necessary. 
❑ Update Edpar table, as necessary, for customers on the new Edpar process for determining sold-to and ship-to numbers for EDI PO's. 
❑ Re-output customer invoices, per requests from A/R. 
❑ Handle any other EDI-related issues that may arise.

EDI Specialist

APS Health Care
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Brookfield, WI
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February 2008 to March 2010

Assisted Providers regarding Medicaid claim issues. 
❑ Downloaded EDI Claims from FTP site to the Claims system. 
❑ Worked with Providers to assist them with EDI claims translation thru Gateway, Thin, and Proxymed. 
❑ Worked all CHC claims and resubmittals after corrections were made. 
❑ Worked with ACS Georgia to ensure that all files processed correctly to APS. 
❑ Worked all the month end reports and distributed them to staff.

EDI Specialist Consultant

Texas Medicaid & Healthcare Partnership
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Austin, TX
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February 2007 to July 2007

Tested and ensured EDI claims went through the EDI translator successfully per HIPAA compliance. 
❑ Pulled TFE files from the Tandem server and dropped into the outbound test environment. 
❑ Tested the 837I, 837P, 837D, 270, 277U, 277P, 276 and 835 using Edifects Specbuilder to research any critical errors. 
❑ Dropped the files into the correct test environment to analyze the output. 
❑ Documented test results and defects in Mercury Test Director. 
❑ Tested 3rd party submitters on all files for contingent and non-contingent for TDHConnect and Non-TDHConnect. 
❑ Researched for correct response files through Claredi for the 997, 271 and 277 TFC files. 
❑ Ensured the correct submitter and receiver ID's were being used. 
❑ Documented weekly status report through BID. 
❑ Communicated with the Developers regarding errors on files. 
❑ Performed quality book reviews in preparation for UAT and State Audit.

Business Analyst

Coventry Healthcare
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St. Louis, MO
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May 2006 to February 2007

Developed and performed functional and integration test plans and test cases for Quality Assurance. 
❑ Documented test results for QA and compliance purposes. 
❑ Analyzed and documented users' business needs for a more productive testing environment. 
❑ Communicated with the Programmer users' issues and test the enhancements for quality results. 
❑ Tested new developments for 3rd party software vendor. 
❑ Mocked up 837 files to test for HIPAA compliancy. 
❑ Worked on the new UB04 and NPI issues. 
❑ Worked on multiple projects simultaneously. 
❑ Tested the 270,271,276,277, 837 EDI transactions. 
❑ Tested the inbound 837I to ensure validation of the NPI number.

Analyst - Consultant

Magellan Health Services
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Maryland Heights, MO
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May 2005 to December 2005

Maintained spec reports to archive files on the IBM mainframe system and moved them to the common drive. 
❑ Assisted trading partners for electronic claim submission with test files prior to going live into production. 
❑ Ran test files through CLAREDI EDI translator. 
❑ Researched and analyzed errors on the test files pertaining to 837I and 837P reports. 
❑ Made corrections to the errors so the programmer could correct his program 
❑ Developed spec reports and gave to the programmer for output data to the client. 
❑ Developed test case scenarios for appropriate reporting to clients prior to going live into production. 
❑ Distributed progress reports twice a week to management. 
❑ Worked with HIPAA compliance laws to ensure compliancy. 
❑ Resolved discrepancies on the 820 per Project Manager's request.

EDI Information Technology Specialist

Tenet Healthcare
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Bridgeton, MO
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December 2002 to May 2005

Wrote technical requirements according to business rules. 
❑ Maintained Medicare denial reports. 
❑ Performed the upload for Medicare and Medicaid remittance advices to run in the auto post program. 
❑ Worked 837P & 837I edit reports to correct discrepancies due to HIPPA regulations. 
❑ Worked edit reports to issue discrepancies to the Clearinghouse 
❑ Maintained multiple EDI translators for claim submissions. 
❑ Translated daily claims processing from the server to the Clearinghouse. 
❑ Balanced claim reports from the Clearinghouse and payers. 
❑ Downloaded claim files from two different systems to transmit into the billers work files. 
❑ Prepared and worked month end reports regarding claims and financials. 
❑ Corrected errors on self pay claim accounts. 
❑ Maintained system security for the department. 
❑ Ran a paper claim run to disperse to the account reps.

Education

Certificate in Business Mid

Milwaukee Area Technical College -
Milwaukee, WI

Additional Information

Skills / Computer Experience: 
 
❑ Microsoft Word, Excel, Access, PowerPoint, Outlook 
❑ Facets claim system 
❑ SSI 
❑ AS400 
❑ Ultra Edit 
❑ CLAREDI 
❑ Proficient in Medicare and Medicaid billing techniques 
❑ 837I, 837P, 835, 840, […] 276, 277, 977 TA1, EFT, X12( 4010 and 5010) 
❑ SOX Documentation 
❑ WebMD 
❑ File Transfer Protocol Process 
❑ Mercury Test Director 
❑ Edifects Specbuilder 
❑ BID 
❑ Tandem 
❑ SAP 
❑ TransGen 
❑ VCXChange 
❑ Visual Claims 
❑ SSIS Packages 
❑ SQL Server Management Studio