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**** * ********** ******, *****, Florida ****3 • Cell: 813-***-**** • ac0ywc@r.postjobfree.com

Professional Summary

Self-motivated Electronic Data Interchange (EDI) Analyst /Medical Biller with 10+ yearsexperience. Experience working directly with providers, payers, and electronic data interchange (EDI)organizations, billing services clearinghouses and government agencies. Excellent technical researchskills

Skills

Microsoft Office, Word, Excel, PowerPoint, HCPCS, ICD-10 (International Classification ofAccess, Google Docs Disease Systems)Term, Unix, Linux, Medical terminology knowledgeMicrosoft SQL, Salesforce, Sharepoint, Jira Billing and collection procedures270,271,276,277,835,837,997,999 Insurance and collections proceduresTaxonomy and Revenue Codes Excellent verbal communicationRecords management professional Resourceful and reliable workerMedicare, Medicaid & commercial insurancecarriers

Professional Experience

EDI Operations Analyst, 05/2014 to 04/2017HEALTHESYSTEMS – TAMPA, FL

Worked with Regulatory and Compliance to ensure timely reporting of workers compensationpharmacy and durable medical claims to Florida, California, Texas, Oregon and North Carolina.Handled all Medical Data Call implementations and reporting transactions to NCCI and CDXreporting services.Reviewed and analyzed business translation of (ABM/PBM/DME products) EDI reportingrequirements and (CMS &NCPDP) standards.Collaborated with internal and external audit requests to conduct in depth compliance audits.Participated in Code Reviews, System Testing and UAT followed by production verification, postproduction testing and supportIdentified specifications for billing and accounts receivablerequirements, performed gap analysis and presented information to technical team to identifysystem requirements.

Developed departmental standards of operations training procedures.Provided post implementation support and performed root cause analysis and fixed postimplementation issues Consistently maintained 95% timely reporting accuracy by providing training to relationaldepartments on intricacies of bill submissions, coding procedures and billing requirements tominimize rejections.Researched and compiled monthly state financial summary reports for internal and externalcustomers.Maintained and updated all files including insurance companies, diagnosis, procedure,fees/profiles.Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation ofrecorded data.

EDI Implementation Technician IV/ Trainer I, 09/2002 to 01/2014VITERA HEALTHCARE SOLUTIONS GREENWAY MEDICAL TECHNOLOGY – Tampa, FL

Implemented all EDI module applications, payment processing programs and third party billingapplications.Communicated with Clearinghouses and insurance companies regarding claims issues, paymentfailures, and other related concerns.Partnered with healthcare payers to implement electronic data interchange solutions for claimsprocessingCreated new processes/procedures/guidelines to leverage dataAccount manager for numerousmulti-specialty accounts billing from $100-$10 million annuallyMedicaid/Medicare Billing subject matter expert (SME) and point of escalation for 10 team members.Utilized Unix/Linux terminal along with VI editor to manipulate/ execute batch processes for timelysubmissionSimplified third party explanation of benefit (EOB) import process for clients, eliminating need tomanually post payments while increasing productivity and reducing errors

Medicaid/Medicare Billing Clerk, 12/2000 to 09/2002TAMPA COMMUNITY HEALTH CENTERS – Tampa, FL

Reduced Medicaid managed care accounts receivable 90-180 day outstanding by 80%Verified all Medicare, Medicaid patient coveragePosted insurance and patient payments Prepared and submitted all paper and electronic bills in timely manner to all payersTracked and followed up on unpaid claims and denials in an efficient mannerEffectively resolved insurance rejections and other billing issues.Prepared billing correspondence and maintained database to organize billing information

Reviewed accounts for possible assignment and made recommendations to Billing Supervisor

Education

Bachelor of Science: Health Science/ Public Health, 2011Kaplan University - Davenport, IA