Revenue Cycle Edi Analyst
Resume:
Daniella G. Chepandova
CONTACT
**************@*****.***
Noblesville, IN
TECH & WORK-RELATED SKILLS
EDI ANCI x12 (837P/I/D, 835,
***/***, ***/***, ***, 275, 278,
999) (IBR, EBR, DPR)
HIPAA
ACE Edits / EDIFECS
Trading Partners Connections
Payment Integrity, PPNEG
Reprice Methodologies
NSA
EDI / Web Service / RESTful API
MS SQL Server Management
Studio / Oracle SQL Developer /
Toad for Oracle / ThoughtSpot
Delinea/Secret Server
ETL
Agile Methodology
Scrum
JIRA / Confluence
ServiceNow
MS & Google Products
Notepad++ / Text Pad /
OneNote / Beyond Compare /
Macros
Tidal/ Active Batch Console/
Control-M
Bitbucket (GitHub)
Splunk
RM837RefCut
Postman
SalesForce
EMR/EHR
LIMS
Epic
Cerner
Javelina
Aprima
NetworX
OCS / AMD
eBridge
MPX
XML / JSON / HL7
HTTPS / SFTP / PGP / SSH
ITIL
Lean Six Sigma
PROFESSIONAL SUMMARY
Healthcare IT Integration Specialist 30+ years in Revenue Cycle Management Expertise in EMR/EHR, LIMS, HL7, FHIR, X12, EDI Connectivity, Testing, Data Integration, Mapping & Quality Assurance.
WORK EXPERIENCE
07/24 – 09/25 RCM Systems Configuration Analyst, NATERA, Austin, TX
Led all levels cross-functional collaboration to establish a standalone non-traditional process and automation, while performing team management and training.
Managed projects for developing and implementing new procedure via phased rollout methods, enabling billing across all contracted payers.
Collaborated with Finance, IT, and Engineering on process improvement initiatives, focusing on automating and optimizing Revenue Cycle Management functions and reimbursement workflows.
Configured and maintain billing system parameters (rules, logic, coding) to ensure accurate and timely billing of products and services. Configured and maintain systems such as LIMS and AMD.
Drove billing process development and maintained open communication with teams at all levels and across qualifications.
Maintained up-to-date documentation of billing configurations and standard operating procedures (SOP).
Provided technical support, troubleshoot complex billing issues, and recommend effective solutions. Analyzed trends and solved issues impacting billing and pre-authorization workflows.
Prepared timely progress updates and reports for management and stakeholders.
Partner with team members to ensure accurate billing processes and compliance.
Managed contract renewals, adjusting billing processes accordingly to ensure compliance and accuracy.
07/23 – 12/23 EDI Analyst II, MultiPlan Inc, New York NY
Successfully designed clients’ profiles and crosswalked data internally using NetworX.
Designed and updated clients’ repricing methodology hierarchies for all clients.
Led close discussions with the clients to communicate company guidelines during the kick-off calls, delivered EOB and testing updates.
Finalized ETL testing in the Quality Assurance Environment and presented the test results to management and also reported those directly to the client.
Completed SFTP set-up requests including close communication with the client.
Performed 30 days warranty monitoring in Production environment to assure accuracy and delivering the best value to the customers.
Progressed the core configuration on complex accounts by using insert scripts.
Navigated through the database by developing SQL queries using Toad for Oracle.
Executed the “run-the-business” tickets daily. Created Change Requests via Service Now.
Initiated projects by filtering the database to deliver advances to the current processes.
Revised the process documentation in Confluence. Maintained Data Dictionary.
05/23 – 07/23 Systems Analyst, General IT, WorldTrips Travel Insurance, Carmel IN
Navigated and corrected discrepancies in Javelina system based on the inbound JSON files.
Leveraged the Backlog Tasks by overseeing and administering accurate outbound files.
Operated different levels of errors: pre-batch, JSON review, diagnostic, crosswalk, and CSR (client service request) using Javelina system.
Participated in weekly and bi-weekly operational meetings with clients and stakeholders.
Initiated study in Plan Building utilizing Javelina.
04/15 – 05/23 EDI Implementation/QA Analyst II, Availity LLC, Indianapolis IN
Enabled seamless collaboration between clients by connecting payers and clearinghouses for efficient data exchange.
Accomplished vast number of projects involving designing, testing, and deploying, using company applications and databases. Acted as SME on all transaction exchanges.
Controlled system setup for new connections according to payer, mode (EDI, Web-Service, or API), and transaction type.
Gathered specifications and business requirements using clients’ companion guides.
Built comprehensive, reusable and sustainable test plans, test cases, and test scripts for ETL process. Used production or deidentified data and analyzed payer response files in the non-production environment.
Orchestrated the client facing interactive screens (the client facing portal) for each 270 API transaction by setting the screen fields with appropriate variables using JSON. Communicated with the development team if core code changes were needed.
Facilitated the transactions settings in GitHub (XML format) to create the job parameters for the staging/batching jobs in the Active Batch Console for the 276/277 transactions.
Developed elaborate SQL queries (utilized MS SSMS and Oracle SQL Developer) to obtain and manipulate data for testing, troubleshooting, deploying, and production monitoring.
Used JIRA project management tool to track user stories.
Directed different phases of testing, such as end-to-end, system integration, user acceptance, functional and non-functional.
Ran Quality Assurance testing on all implementations and narrated ways to automate EDI processes to reduce maintenance requests. Identified and implemented continual improvement initiatives to help advance overall quality.
Performed 30 days production monitoring on all new connections by querying the database.
Conducted maintenance on internal or client requests. Analyzed information for trends. Used Splunk when needed.
Collaborated with cross-functional teams in agile ceremonies, daily stand-ups, bi-weekly Sprint reviews, and planning session to enhance data integration capabilities and develop optimization strategies to meet functional requirements and scheduled targets.
11/13 – 04/15 Senior Coding Specialist at IU Health Cancer Center, Indianapolis IN
Manually entered HCFA and UB claims into the Epic system, ensuring accurate coding to facilitate clean claim submissions.
Edited and processed claims to ensure compliance with payer-specific guidelines and regulatory requirements.
Collaborated with internal teams to identify and resolve claim discrepancies, improving the speed and accuracy of claim resolutions.
Supported the integration of new coding standards and updates into the Epic system, reducing claim rejections by 15%.
Assisted in training staff on claim submission best practices and Epic workflow efficiencies.
04/08 – 06/13 AR Specialist, Coding and Billing at RMG Central Billing Office, Riverview Health, Noblesville IN
Oversaw the manual entry of HCFA claims into the PM system for all Riverview affiliated providers, ensuring correct coding and clean claims submissions.
Utilized Epic Systems for claim generation, submission, and tracking, improving claim accuracy and reducing rework.
Managed the accounts receivable (A/R) process, ensuring timely follow-up on unpaid claims, resolving denied or underpaid claims, and maintaining accurate billing data.
Monitored and reviewed A/R aging reports, reducing the overall outstanding A/R balance through timely follow-up and dispute resolution.
Worked directly with insurance companies to ensure proper payments, resolving discrepancies and submitting appeals for denied claims through Epic’s claims management interface.
Corrected claims electronically using services like Allscripts and Availity, ensuring accurate claim data across multiple platforms.
Assisted with charge capture and claim coding, ensuring compliance with payer guidelines and accurate reimbursement.
Trained and mentored new team members on A/R management, and industry best practices.
EDUCATION
02/2015 – 09/2016 Information Technology, Harrison College, Indianapolis, Indiana
(70 college credits, GPA 3.93. Vocational)
10/1988 – 06/1995 Mathematics & Informatics, Sofia University, Sofia, Bulgaria
(Bachelor's Degree in Informatics and Mathematics)
10/1984 – 06/1988 Professional Affiliation Math Gymnasium, Blagoevgrad, Bulgaria
(Extended studies in Mathematics and Computer Programming)
LANGUAGES
ENGLISH – Fluent, BULGARIAN – Fluent, Russian - Basic
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