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EDI Specialist

EDI Specialist

Milwaukee, WI


Work Experience

EDI Specialist

Sheboygan, WI

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
Brookfield, WI

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
Austin, TX

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
St. Louis, MO

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
Maryland Heights, MO

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
Bridgeton, MO

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.


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 
❑ 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