Administrative Assistant Business Analyst
Resume:
Robert Neal Spector
Los Angeles, California 90034
562-***-**** mobile
******.*********@*****.***
Summary
Seasoned and versatile EDI Analyst with 20+ years of experience in supporting, developing, analyzing, managing, deploying, mapping, documenting, establishing communication with trading partners, processing, and implementing EDI processes. Well-versed with Jira, billing process, EDI X12 transaction sets and customer service. Proficient with HIPAA business processes, compliance, technical infrastructure. Skilled with ServiceNow, real time connectivity, MS Teams, and SNIP validations.
Highlights
Used Edifecs Analyzer to enable inbound / outbound HIPAA EDI transaction in support of HIPAA 834, 5010, 4010 version transactions.
Proficiently created HIPAA business processes / rules, edited specifications documents to correct and / or reject inbound 837 billing claim files prior to loading into facets.
Implemented HIPAA transaction guidelines for ANSI X12 820, 834, 835, 837 billing claim, 270, 271.
Involved in full HIPAA compliance lifecycle from gap analysis, mapping, implementation, and testing for processing of Medicaid claims.
Created educational presentations, presented internal courses on 997 file format, HIPAA data system, 837 file formats, looping structure, and data requirements.
Adhered to HIPAA security and privacy regulations related to patient information.
Professional Work Experience
EDI Support Analyst
10/2022 – present
Deloitte, Orlando FL.
Provided front-lineTrading Partner and Provider support during system conversion and go-live implementation for State of Ohio Medicaid. Responsible for timely resolution of ServiceNow incident tickets, phone support using Splunk, Finesse, Jabber, Jira.
EDI Consultant
Apr 2022 – Sep 2022
CDPHP, Washington, DC
Worked within HIPAA business processes and business rules to make sure that EDI transactions are passed.
Ensured incoming and outgoing transactions followed HIPAA standards.
Provided Subject Matter Expert (SME) level analysis / direction.
Involved in bringing in-house processing and delivery of HIPAA transactions 270/271 patient eligibility inquiry & response.
Created functional specifications for proposed new system.
Used MS Teams for internal departmental communication and meeting invites purposes.
EDI Integrations Analyst
May 2021 – Oct 2021
Pacific Dental Services, Irvine, CA
Functioned as Subject Matter Expert (SME) on ANSI X12 files within a complex IT environment using Epic, MuleSoft, Salesforce, Jira, Scrum task management, and Confluence documentation version control.
Developed / documented mapping and processing specifications for EPIC inbound HL7 v2.3, ANSI 270 / 271 eligibility, HIPAA transactions 834 enrollment, 835 remittance, & 837D claims files for translation to JSON schemas for import to MuleSoft APIs.
Monitored daily production processing using nJAMS to determine processing error points, reporting, and followed up on status resolution.
EDI Analyst
Nov 2017 – Jan 2018
Cigna HealthSpring, Nashville, TN
Developed specifications, documentation, and file transformation maps in Edifecs to convert (ANSI) X12 HIPAA transactions 837P, 837D and 837I to WPC proprietary XML structures for processing.
Monitored projects and defect management using Jira.
EDI Analyst May 2014 – Jan 2015
CareMore, Cerritos, CA
Determined end-user requirements, implemented Edifecs based solutions for new business lines, enabling acceptance, delivery of (ANSI) X12 HIPAA transactions 834, 820 using SpecBuilder version 8.3 for mapping, guidelines, and severity files.
Developed T-SQL procedures used to update facets-based enrollment tables.
Created HIPAA business processes / rules, edited specifications documents to correct and / or reject inbound HIPAA transaction 837 billing claim files prior to loading into facets.
Used facets support systems to enable inbound / outbound HIPAA EDI transaction in support of HIPAA 834, 5010, 4010 version transactions.
EDI Analyst / Consultant
Jul, 2013 – May 2014
BCBS Richardson, TX
Managed the project to transform complex legacy data structures into standardized (ANSI) X12 files
Replaced WTX based system using new Edifecs routes, maps, and guidelines to support State of New Mexico’s Centennial encounters reporting system
Developed a technical infrastructure i.e. cohesive privacy policy, hired dedicated security staff, an internal auditing process, specific email policy, understand breach notifications requirements, and secure relationship with business associates
EDI Analyst Jul 2012 – Dec 2012
Kaiser Permanente, Los Angeles, CA
Worked as a Subject Matter Expert (SME) on ANSI X12 HIPAA transaction 277 set posting into HealthConnect claims system
Coordinated with Patient Financial Services (PFS) process owners, internal payers, and RelayHealth clearinghouse on Revenue Cycle Management (RCM) enhancements
Responsible for mapping inbound status HIPAA data to assigned work queues
EDI Analyst Jan 2011 – Mar 2012
NexVisionIX, Irvine, CA Developed / implemented Edifecs solutions for key healthcare clients.
Involved in analyzing, designing, coding, and testing of Edifecs software including SpecBuilder, MapBuilder, JavaScripts, XEngine, and TPM.
Designed / development of test cases based on functional requirements.
Worked on projects include version 4010 to 5010 step-up / step-down for ANSI X12 HIPAA transactions 835, 837, 270 / 271, 276 / 277, and 999.
Involved in development of custom validation guidelines and HIPAA data conversions of ANSI files to XML, NCPDP, COBOL copybook, and other proprietary data formats.
Senior EDI Production / Research Analyst
May 2004 – Dec 2010
Capario, Santa Ana, CA
Coordinated efforts between payers, vendors, and internal development departments to resolve errors with inbound HIPAA transaction 835 ERA and 837 claims.
Monitored various run-time / real time processing points, performed root-cause analysis for resolution, and client notification.
Supported providers / vendors by serving as second-tier customer services support for difficult issues with inbound claims in 837 claim, NSF or HCFA1500 formats.
Created educational presentations, presented internal courses on 997 file format, HIPAA data system, 837 file formats, looping structure, and data requirements
Mentored junior staff as needed as the HIPAA compliance Subject Matter Expert (SME)
Education
Bachelor of Arts, Economics, University of California, Santa Barbara, CA,
Additional Information
N/A
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