Healthcare Analyst Business Processes

Kristen Schroeder

EDI Healthcare Analyst

**** ******** **, *****, ** 14047, 716-***-****, ***********@*****.***

PROFESSIONAL SUMMARY

I am a passionate technical professional with 18+ years’ experience successfully executing tasks and responsibilities assigned to me over the course of my career. I successfully led the EDI Team at Independent Health through NPI Only, 5010 and ICD-10 implementations. I achieved and maintained a 0% disclosure rate for my entire tenure with Independent Health and BiTS by paying strict attention to detail, implementing process improvements and automations whenever possible and being diligent with peer reviews.

Over the course of a yearlong project, I converted 75% of all company business processes to electronic processes. I replaced hard copies with an electronic document storage process whenever regulatory mandates allowed. I repurposed an application that the company already had an existing subscription to, resulting in a 50% cost savings in document storage costs.

I love to gain new skills and learn new things. I have frequently been asked to assume a role or complete a project where I am not familiar with the data or tools involved. I am effective because I learn new technologies very quickly and I love a challenge.

I have been consistently recognized by senior management and my peers for being a team player.

SKILLS

Intermediate level SQL

Expert in data mapping/translations

Excellent attention to detail

Experienced KPI/Metrics development

Skilled with requirements gathering

Great healthcare operations business acumen

Expert in Healthcare EDI and X12 transactions

Experienced in using database structured reporting tools such as Crystal Reports & Cognos Cubes

AS400 & HealthEdge/HealthRules Core Platforms

Setup, configuration and support of file transfers and the tools and protocols

Agile Product Management using Jira and Confluence

MS Office Suite

Experienced in the full life cycle of technical development

Experienced in many data types used in healthcare and their implementations

EXPERIENCE

Business Information Consultant Senior January 2022 – August 2023

Elevance Health Norfolk, VA

Evaluation of technical issues, testing and validation of solutions

Extensive working knowledge of healthcare claim/encounters, edits and adjudication/reimbursement

Maintains knowledge of industry standards, compliance regulations and upcoming changes

Excellent communication skills with associates at all levels

Analyzes and queries data

Subject matter expert on EDI X12 file formats (837, 835, 277, 277CA, 999)

Interim Product Owner for the IT Team developing the encounters related reporting solutions

EDI Systems Analyst (Consultant) September 2021 -January 2022

Elevance Health Norfolk, VA

Manages integrated functionality, usability, reliability, performance, and support requirements of a system.

Creates feature test strategies and environment needs.

Provides the link between the technical and business views of the system by ensuring that the technical solutions being developed will

Applies and mentors use of tools to define requirements.

Anticipates and identifies opportunities for improvement.

Ensures high level designs including architecture requirements are accurately documented and map to approved requirements.

Assists in developing training documentation and proactive identification of additional documentation needs.

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Customer Support Manager/EDI Specialist/Technology Evangelist/Systems Admin

Founders Holdings Co./BiTS/The Cedar Bus Co. Buffalo, NY

July 2017 – July 2021

Compile payer ANSI X12 format requirements and translate them to Jira issues for the development team to create new formats or update existing formats due to changes

Write test cases for development requests and execute and analyze results

Research new brokers and payers. Identify the processes we will need to accommodate in our product(s)

Develop business processes that will ensure accurate and timely claims submission and payment

Review rejections customers have received in response to claim submission and explain what they need to correct or work with development to update the software

Manage the top customer implementations from beginning to end, ensure full adoption

Use existing functionality to achieve the customer’s goals whenever possible

Recognize when software customizations will be necessary to achieve the customer’s objectives

Demonstrate added value with every customer interaction

Perform all Salesforce Administrator responsibilities

Ability to communicate technical product information and concepts effectively with associates, leads and customers with all levels of experience and education verbally and in writing

The discretion necessary to work with and handle PHI and sensitive data

Senior EDI Analyst

Independent Health Association Williamsville, NY

August 2005 - September 2016

Provide timely, professional support to trading partners, software vendors and/or their clearinghouses as well as internal departments

Responsible for ensuring all data loads to the appropriate system(s) accurately, completely and on time. This includes claims, membership, eligibility, remittance, provider loads and Explanation of Benefits as well as response files or reports generated from the processing of data.

Proactively review all systems and/or response files to validate file transfers and data processing

Resolve any file transfer/data load issues that arise within any systems

Periodically review the EDI schedule to ensure that it is executed on time and no efficiencies can be made

Pull and load files for non-automated processes

Validate Foresight claim edits as needed

Execute all new trading partner setups including transmission method, mapping, translation, onboarding, and testing

Defines and performs EDI system testing and quality control checks

Develops and maintains EDI documentation available internally and externally

Maintains and reviews the EDI system's performance (acknowledgments, communication, translation) and monitors the status of daily transmissions (Checks & Balances)

Review upcoming regulatory requirements and lead the team through successful, compliant implementation

The discretion necessary to work with and handle PHI and sensitive data

Consumer Relations Representative

Fisher-Price East Aurora, NY

October 1998 – August 2005

Take incoming consumer phone calls regarding product questions and or problems

Resolve the issue to the satisfaction of the customer and the company

Maintain product knowledge base

Provide technical and assembly support on products

EDUCATION

Regents Diploma

West Seneca East Senior High School, West Seneca, New York 14224

June 1997

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