Healthcare EDI SME
Resume:
Mona Haeri
Fairfax, VA 22033
Home: 703-***-****
Email: ******@*********.***
Background Summary
9+ years of experience as a QA Analyst/Tester in HealthCare IT Field.
Diverse industry and functional expertise with success and accomplishments in all aspects of healthcare accounts receivable lifecycles, including health plan, clearinghouse and provider processing systems.
Subject Matter Expert for Transactions Code Sets and Identifiers
Experienced in analyzing, gathering, detailing, documenting, validating in gathering business process information
Educated in HIPAA Health Information and Security & Privacy requirements
Understanding of Visual Basic coding and SQL database applications
Excel VBA macro scripting skills in Windows/XP environment
Experienced in Relational Database and maintenance of Client/Server applications
Proficient in healthcare EDI systems and electronic claim transaction technology
Excellent Mathematical, Analytical & Problem Solving skills and a good team player
OPERATING SYSTEMS:
Windows 2000, Windows NT, Windows XP, SQL Server
Software:
ProComm Plus, Microsoft Word, Microsoft Access, Microsoft Project, Visio,
Visual FoxPro, Turbo C, Visual Source Safe, Visual Intercepts, WINMAP, Microsoft SharePoint Portal , Rational Clear Case, QMACS, Affinity, Cache, PeopleSoft, TestTrack.
.
Work History
Revenue Cycle QA, Quadramed Corp., Reston, VA 07/05 Present
• Performed quality assurance and analysis responsibilities for developing EDI financial hospital software applications.
• Provided assessments and gap analysis documents on conversion of X12 4010 into 5010 version for 837 and 835 transactions.
• Provided technical competency in support of a multi-vendor software.
• Tested new developments of X12 837 claim, 835 payment files and ensured timely and quality delivery of Revenue Cycle product releases.
• Reviewed, analized and tested State regulatory Data Discharge Reporting formats for a number of states.
• Performed quality assurance and testing on National Provider ID project. Ensured valid segments were generated for providers sending NPI and/or legacy numbers. Tested NPI for billing, attending, referring, operating and other physician types as well as group provider for 837I & 837P.
• Created test cases and contributed to the functional design and qa for National Drug Code data for the Medicaid Rebate Reporting program that needs to be reported in the revenue section of the UB-04. These data were sent via HL7 outbound files and processed by affinity.
• Participated in functional design and qa for CMS requirements on the completion of a Present on Admission (POA). Recommended solutions on how to incorporate this data into our system and tested X12 files.
• Involved in testing of conversion of HCFA 1500 into new CMS1500 form.
Software Engineer IV, Unisys Corp, Reston, VA 09/03-07/05
• Assisted with testing and implementation of X12 HIPAA standards for 837 and 270/271 using QCSI/QNXT software and tools.
• Assisted in testing and design of patient payment system by performing data analysis using SQL queries.
• Performed QA and unit testing on WV MMIS provider enrollment applications in Virtual Work flow web environment.
• Played a major role in integration team for WV MMIS claims processing system from legacy to HIPAA compliant system by researching, designing, modifying system components, identifying the required steps and recommended solutions for them to comply with HIPAA rules. The tool used was Instream HIPAA Validator, which provided WEDI level 1 through 7 edits and validations and produces functional acknowledgement 997.
HIPAA Consultant, Unisys Corp, Reston, VA 09/02-09/03
• Provided sales support -- complete portions of proposals (including EDI gap analysis & researched HIPAA validation tools) and conducted demonstrations.
• Developed security policies templates for both HIPAA and GLBA.
• Maintained and supported Military Health System database for Tricare client.
• Contributed to the development and review of System Security Authorization Agreement documents, Physical Security, Audit Matrices and Risk Assessment Reports for MHS client.
• Involved in information systems certification & accreditation (C&A) process for DITSCAP as an Information Security Analyst.
Product Analyst, WebMD Corp., Fairfax, VA 01/00-09/02
• Acted as the company's liaison with providers and electronic insurance carriers, and other "partners" in keeping up with their changing electronic submission and reporting requirements.
• Analyzed payer requirements for completeness and drive programming tasks.
• Reviewed payer billing manuals to recommend new changes and edits on client software.
• Identified root cause analysis on disruptions to production systems.
• Wrote tasks and supporting test cases derived from an analysis design and programming specifications.
• Tested software using these tasks, document results, defects and issue resolutions.
• Wrote VB script programs to automate claim-processing procedures for the clients.
• Quickly resolved problems. Worked directly with programming team and motivated them.
• Contributed to the development of timelines and managed work to meet the project schedule.
• Participated as reviewer, facilitator and problem solver to promote quality and consistency.
• Responsible for implementation of new payer edits (UB & NSF formats) into our software.
• Responsible for reviewing Medicare newsletters and WebMD customer service bulletins.
• Was instrumental in migration of CareFirst project from MHIN to Blue Cross DC through WebMD both as a research analyst and QA by obtaining business requirements for EDI claims from CareFirst, provided feedback on WebMd existing and discussed MHIN edit requirements with business analysts, communicated edits and changes with programming team and the management.
EDI Consultant, PaperFree Systems, Vienna, VA 2/99-01/00
• Performed quality assurance and testing on company mapping software (Winmap).
• Developed complex 837 institutional and Medical maps using ASC X12 (i.e. ANSI 4010) standards.
Application Analyst, Per-SE Technology, Elgin, IL 2/95-2/99
• Maintained and modified FoxPro & Visual FoxPro applications.
• Involved as an analyst in the requirement analysis, coding, testing, and implementation of customized applications for health insurance companies utilizing SQL & Visual FoxPro.
• Responsible for writing original software for payer EDI interface.
• Provided supervisor with documentation as was required in conformity with procedures.
• Monitored production transactions and maintained changing payer requirements in Healthcare EDI system.
Programmer (Temp position), Decision Software Systems, Chicago, IL 9/94-12/94
• Assisted with the coding of FoxPro programs
• Designed screens for data entry and developed customized software for a variety of business applications such as accounting and inventory.
System Specialist Assistant (CO_OP), City of Chicago, Chicago, IL 9/89 -12/89
• Designed flowcharts, created and prepared financial reports using Lotus.
Education
B.S. Math and Computer Science, University of Illinois at Chicago, 1991
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