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Customer Service Quality Assurance

Covington, Georgia, United States
October 12, 2016

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** ******* ***** 404-***-****

Covington, GA 30016

Highly organized and detail-oriented Support Professional with over 7 years of EDI Support and Billing experience. Offering excellent client relations and communication skills acquired by working with Trading Partners specializing in various areas of technology. Able to multitask projects simultaneously with core competencies in: Office Administration Troubleshooting Customer Services Networking Technologies Medical Collections SQL AS/400 FTP/SFTP/FTPS Emdeon Quality Assurance VAN EDI-X12-XML JD Edwards Trusted Link Showcase Query Sterling Commerce PROFESSIONAL EXPERIENCE:

EDI COORDINATOR June 2014 – Present Duluth GA


● Monitor all inbound and outbound EDI transactions; troubleshoot all processes to resolve content and mapping issues.

● Streamline communication and processing flow problems.

● Work collaboratively to insure successful deployment of EDI implementations. Manage all communication from customers/vendors to developers.

● Collaborate and build strong relationships with Customers/Vendors to ensure timely billing, collection and payment of receivables. (Home Depot, Lowe's, Wal Mart, Ace Hardware, Menards, Orchard, Sears, Kmart) etc.

● Assist A/R analysts with Customer portfolio research and remittance issues affecting payments.

● Provide support to System Administrator with new Customer implementations, for EDI transactions.

● Order Entry, manual and/or monitor EDI orders.

● Monitor the order throughout the life cycle.

● Process and upload daily Positive Pay batch transaction.

● Complete and track all EDI enrollment paperwork. Complete license renewals.

● Handle errors related to EDI documents (810, 820, 823, 855, 856 & 850), while providing technical support to all EDI applications.

● Managing Customers EDI Inbound functionalities to determine trends, root cause analysis, a resolution plan or present issues requiring escalation to management teams.

● Contacting plants and licensees. Support activities include SKU maintenance and Item Data Management maintenance.

● Import Monthly Reconciliation batch file into system from Banking Financial Institution.

● Coordinate new SKU set-ups and source UPC creation.

● Make sure all electronic data transfer is done within required timeframe.

● Monitor all incoming orders to reflect customer's order requirements and the organization's shipping policy.

● Perform systems tasks to ensure uninterrupted service to external customers and trading partners.

● Establish Quality Assurance procedures for EDI X12 Supply Chain transactions version 4010 (810, 820, 850, 855, and 856).

● Work with other departments to achieve excellence in time management, resolution and general support.

● Coordinate with Third Party EDI and new Trading Partners to set up new processes and provide optimal level of customer services.


GENTIVA HEALTH SERVICES May 2009 – June 2014 Atlanta, GA

● Ensure Inbound/Outbound electronic transactions are in compliance with HIPAA standards.

● Identify and resolve issues to insure uninterrupted billing and follow-up processes.

● Assist in the resolution of outstanding payments from past due accounts.

● Obtain Trading Partner Agreement Contracts, Submitter IDs…etc

● Troubleshoot coding errors on ANSI X12N EDI documents which include: 837 (Institutional/Professional) Claims, 277, 834 and 835’s Remittance.

● Complete and maintain all EDI enrollment paperwork with Trading Partners.

● Maintains all Account ID’s, TIN, NPI and Provider# records.

● Collect all necessary patient, demographic, and insurance information/documentation to ensure a patient is completely registered.

● Perform insurance eligibility and benefits verification.

● Perform collection functions and refer patients to Financial Counseling when needed.

● Ensure timely receipt of claim payments and minimizes bad debt accrual.

● Manage bill/claim follow-up by phone, payer website, clearing house and/or email for aged account balances as necessary.

● Research issues that arise related to EDI transmissions between Trading Partners.

● File all 999 and 997 Transaction Acknowledgments.

● Ensuring cash goals are met on a monthly basis and accounts are appropriately coded to system for management of open accounts.

● Manage Financial Service Unit department’s Employee Insurance User ID and Password Database. (Medicare, Medicaid, BCBS, UHC, Cigna, Aetna) etc.

● Document all EDI rejection notice on patient accounts and forward to assigned Patient Account Rep to be worked.

● Work directly with Office Administrators, Contracting/Licensure and Cash Department in a team environment, to deliver quality, satisfaction, and resolution.

● Document processes for new product introductions for Inbound/Outbound electronic transactions, and make sure we are in compliance with HIPAA standards.


ATLANTA CANCER CARE July 2003-May 2009 Atlanta, GA

● Manage a high volume work load within a deadline driven environment

● Researches and resolves denials received daily.

● Correct and resubmit Paper and EDI rejections for processing.

● Adjust accounts receivable entries in accordance with existing operating procedures.

● Identify need for insurance changes or updates and completes required forms to initiate request.

● Thoroughly investigate every account billed to third party payers.

● Transfers balances to correct payer. Analyzes and clears payment variances.

● Utilizes various resources to determine patient’s eligibility, benefits and health plan confirmation.

● Initiate Appeals request per payer guidelines.

● Establishes payer filing limits to ensure that follow-up is completed within the established timeline to ensure claim payment.

● Initiates re-bill of unpaid or underpaid claims.

● Identify claim issues regarding (Coordination of Benefits, Pre-Existing Reviews, Incomplete ICD-9 & 10 coding, Modifier Issues).

● Utilizing clearing house reports and tracking to identify electronic claims submission issues.

● Analyze and interpret accounts/cases regarding charges, payments and balances according to the established state-specific guidelines and the Company's policies and procedures.

● Re-Bills insurance companies or other third parties to secure payment for patients.

● Timely and appropriate resolution of all assigned accounts for third party payors and/or patients with the purpose of managing account receivables balances.

● Uphold Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing and collections.

● Maintain confidentiality and adhere to the HIPPA guidelines/regulations.

● Handle billing calls from patients and clients.


Emory University (Continuing Education Program)

SQL Course Atlanta, GA

Prospect Heights High School

Academic Diploma Brooklyn, NY

AWARDS: Associate of the Month Excellence in Customer Service

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