Eric P. Phillips

*** *** ******, *** **

Easton, PA 18042

201-***-****

E-mail: adzgp6@r.postjobfree.com

Education

****- **** ********** ** *******

Masters - Information Systems, GPA 3.95

2001- 2004 California State University, Monterey Bay

BS - Business Management, GPA 3.2

Experience

Infinittna- Junior Migrations Engineer

Jan 2020- Present

Responsible for Interface related functions, including but not limited to monitoring, support, backups, maintenance, and reporting.

Responsible to be the first responders related to Interface functions

Responsible for ensuring to compliance and standards.

Traveling onsite to diagnose or build Interface related solutions as needed

Building and Implementing Interfacing solutions as well as maintaining integration solutions.

Provide varying degree of support (phone, in person, on-site, or as required) related to interface. Provide technical service and troubleshoot thoroughly. Report and/or document escalations as needed. Identify technical issues and provide resolution to customer.

Documentation – System Design, Software and Implementation documentation – Technical and non-Technical. Test Processes and Information Gathering with the goal of improving test processes and quality and efficient of product.

Projects and Professional Services including and not limited to Interface Migrations, Upgrades, Go-Live Support, Database Exports, HL7 Interfaces and Customizations.

Any duties that may be relevant and industry acceptable an Interface Specialists such as After-hours Support, Off Hour projects and upgrades may be asked and/or required to meet deadlines.

Evicore- Claims Examiner

Jan 2019- January 2020

Responsible for the review, evaluation and processing of medical claims.

Applied proper claim concepts, rules and practices, ensuring accuracy and timeliness of claims payment through demonstrated knowledge of medical terminology, health insurance plans and medical billing concepts.

Learned different claims platforms within eviCore and client’s claims platforms when necessary.

Displayed initiative and ability to work independently on investigation and research of claim inquiries and refer questionable claims appropriately for escalation.

Confirmed member eligibility and claim pricing.

Verified authorization and service appropriateness.

Complied with departmental policies, procedures and goals.

Processed Review of Service Request notifications that do not require certification of medical necessity

Promptly transferred Review of Services calls which cannot be completed via the formal script to a Clinical First Level Reviewer or Medical Reviewer for completion

Work with sites, patients and physician’s offices to investigate and resolve any pre-certification questions or concerns and preempt unanticipated issues

Advanced to Precision Team to process Specialty Drugs, Chemotherapy, Radiation Therapy, Lab, and Sleep cases.

ManPower (Evicore Contract)- Claims Examiner I

Jan 2019-July 2019

Responsible for the review, evaluation and processing of medical claims.

Applied proper claim concepts, rules and practices, ensuring accuracy and timeliness of claims payment through demonstrated knowledge of medical terminology, health insurance plans and medical billing concepts.

Learned different claims platforms within eviCore and client’s claims platforms when necessary.

Displayed initiative and ability to work independently on investigation and research of claim inquiries and refer questionable claims appropriately for escalation.

Confirmed member eligibility and claim pricing.

Verified authorization and service appropriateness.

Complied with departmental policies, procedures and goals.

Catholic Charities- Diocese of Charleston

July 2016- July 2018- Regional Coordinator

Developed and implemented services programs for the community in Beaufort, Jasper, Colleton, and Hampton counties.

Facilitated operations through client advocacy and locating further resources for assistance such as coordinating donations with national agencies, independent groups affiliated with local parishes, and drives with the local communities.

Trained and managed two client advocates as well as a team of 80 volunteers on computer systems and their daily tasks.

Created policies on mandatory reporting, confidentiality, strategic management plans, and business plans for four counties.

Upgrade system with latest updates.

Used Root Cause Analysis (RCA) with the use of data mining tools to provide statistical data and trends for the poverty issues of local community and presented the analysis to local stakeholders such as priests, local government officials, and my internal directors.

Lead the construction and opened a new center that provides financial assistance, classes for occupational assistance, disaster response, postal assistance, personal care facilities, immigration legal assistance, food assistance, and a thrift store.

Emblem Health

August 2013 – Late June 2016- Rates Specialist

Utilized Cognos reporting platform for the Access database queries to perform a RCA and ensure that facilities are implemented with the correct networks such as SelectCare, FIDA, and MLTC contracts to within the required SLA (Service Learning Agreement) has been met. Reports were delivered to department heads and stakeholders.

Managed the consolidated provider file application with the use of data mining tools such as Cognos applications and Access databases for new facility configurations, termination, mergers, demographic and license identification changes for real-time feeds to downstream claims, pre-authorization, and Web directory systems in accordance with the required SLA.

Supported operational and system enhancement projects with the change management teams in accordance to corporate goals and objectives by developing release management techniques to gather business requirement documentations, execute UAT scenarios for validations of project scope using Microsoft Office applications such as Microsoft Excel and Access as well as the utilization of SharePoint in order to meet the SLA timeline.

Created and implemented necessary inventory controls databases, developed workflow documents, and turnaround times with the use of Microsoft Office applications such as Word, Powerpoint, Access, and Excel.

Developed internal SLA with business partner areas such as the Contract Loading Change Management team, external emails and contractors to ensure high priority inquiries are properly tracked, communicated and handle in a timely manner.

Conducted a weekly audit to ensure that all the systems were populated properly.

Supported daily operations of large volumes of claims for 3 million members and ensure production standards and regulatory SLA times are met annually.

Facilitated processing claims with various reimbursement methodologies such as Ambulatory Payment Classifications (APC), Ambulatory Surgical Center (ASC), Long-Term Care Hospital (LTCH), Ambulatory Patient Groups (APGs), and Manage Long-Term Care.

New York Presbyterian Hospital

October 2011- August 2013 – Data Integrity Analyst

Responsible for leading AllScripts clinical information Change Management team and utilizing release management techniques for software testing, troubleshooting, and implementation.

Monitored the Enterprise Master Patient Index (EMPI) and Eagle platform for discrepancies in patient records and correct issues as needed.

Worked with HL7 inbound and outbound interfaces through the Allscripts Touchworks platform. Defined data specifications and mapped data crosswalks. Managed various interface messages to research the root cause and address triggers such as A01, A02, A03, A04, A05, A08 and other messages such as Admit Discharge Transfer (ADT), Orders (ORM), and Results (ORU). Bridged errors in the Allscripts’ ConnectR queue.

Created lists using datamining tools such as T-SQL scripts to extract data from the databases and indexes to create weekly reports, pivot tables, and worklists for team member dashboards, department heads, and stakeholders.

Corrected issues in patient registration and clinical data within the New York Presbyterian hospital system and outpatient site affiliates to ensure data integrity using patient records and PASSPORT Onesource for insurance information within the required SLA.

Lead supporting analyst for end-users, company-wide to resolve database and software issues utilizing remote desktop tools.

Performed RCAs and troubleshot system wide issues then present ad hoc reports to upper management and advised project team members.

ColumbiaDoctors Information Systems

February 2009- October 2011 – Data Quality Analyst

Conducted RCAs on the Allscripts’ “CROWN” EMR for Columbia University/ New York Presbyterian Hospital and corrected electronic updates and interface error logs within the Physician Organization. Was team liaison with patient registration and clinical staff.

Created lists using datamining tools such as T-SQL scripts to extract data from the databases and indexes to create weekly reports, pivot tables, and worklists for team member dashboards.

Trouble shooter for the department charged with investigation of patient data quality problems and to correct or facilitate the correction of these problems.

Present weekly analysis to the appropriate Physicians Organization management.

Team leader - trained new team members including the supervisor for the Data Quality Team to perform the necessary job functions.

Coordinated with system managers, data quality coordinators, and project team members from the various registration systems to ensure data quality.

Met with customers to determine their needs, gather and document business requirements, communicated with customers throughout the development project to manage customer expectations, resolve issues, and provide project status.

Participated in application testing and interface testing for clinical information and practice management systems.

ColumbiaDoctors Information Systems

November 2007- February 2009 – Database Analyst

Implemented various updates and applications using Software Development Life Cycle (SDLC) from work-flow analysis, gathering requirements definition from end-users and stakeholders, documentation, use cases; to unit testing, acceptance testing, deployment and maintenance. Applications included Ingenix and GlobalWorks’ systems.

Created T-SQL scripts to manipulate data using a Database Management System (DBMS) to extract patient data for duplicate patient accounts.

Used the National Provider Identifier (NPI) to update provider’s information in the database.

Provided technical support to clinical departments.

Trained and provided ongoing support to front line users.

Updated patient information, analyzed, and merged duplicate accounts in GE Centricity to ensure that the correct accounts will be billed. Identified ongoing issues and worked with senior management to trouble shoot.

Completed a Policy and Procedure manual for ColumbiaDoctors Information Systems.

Columbia University Medical Center, Ophthalmology Department

November 2006-November 2007 – Program Coordinator/Clinical Trials Coordinator

Established community screening sessions through contacts with community organizations, health care facilities, commercial entities, etc. Coordinated the staffing and logistics.

Utilized telecommunications, planned educational meetings, and perform advertising within the community.

Worked on-site with the physicians and other staff members to screen patients and perform clinical tests such as Visual fields and Visual Acuity.

Ascertained patient compliance with recommended appointments and track results of eye examinations.

Develop and implemented NIH (National Institute of Health)/NEI (National Eye Institute) sponsored clinical trials, as well as investigator initiated research projects and clinical workflows.

Co-coordinated for all the department’s research protocols in various diseases including age-related macular degeneration, diabetic macular edema, diabetic retinopathy, and neuro-ophthalmology.

Assisted with conducting patient visits/procedures, regulatory documents, clinical research form completion, data clarification and site monitoring. Compiled and maintained study binders.

Prepared budgets and IRB (Institute Review Board) submissions.

Technical Skills

Excellent verbal presentation and writing skills

Computer troubleshooting, and office skills

Proficient in Windows OS, Microsoft Word, Excel, Power Point, Visio and Access

Skilled in Allscript’s EMR front-end and back-end operations

HL7 interpretation for interface errors

Indepth experience in GE’s IDX/Centricity especially in patient data analysis

Checking of supplied data for sense, consistency and accuracy.

Sound understanding of relational databases.

Experience with SQL/Server T-SQL for datamining

Advanced experience with Cognos 10 to datamine information for report building

Professional Training

Centricity, NPI, Allscripts EMR, HL7, DBMS, EAGLE, PASSPORT OneSource, EMPI, WEBCIS, ConnectR bridging utility, CMS, Ontrac, Ingenix, GlobalWorks, Cognos 10, Burgess, Webstrat, Sharepoint, Project Portfolio Management, and Consolidated Provider Files (CPF) applications

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