Social Worker

• Jun 2016 - Present

EDI Customer Service Representative

• Mar 2009 - Oct 2011

• Responsible for procuring the appropriate documentation from our clients. • Responsible for preparing these documents to be sent to the appropriate payer for payment. • Facilitation of our electronic billing processes, dealing with both external customers and internal • Responsible for procuring the appropriate documentation from our clients. • Responsible for preparing these documents to be sent to the appropriate payer for payment. • Facilitation of our electronic billing processes, dealing with both external customers and internal

Computer Operations Supervisor

• Jul 2006 - Mar 2009

Computer Operations Supervisor· Supervised ten computer operators in planning, designing, scheduling and supporting computer operations. · Analyzed, researched, and evaluated Electronic Data Interchange (EDI) files. · Achieved 99% maximum up-time, performance, and support of operational systems. · Analyzed, executed, and documented system operations requirements and information delivery processes within integrated delivery systems.

Senior Business System Analyst

• Aug 2003 - Jul 2006

Maintained Diamond System files by configuring the system to pay based on contractual arrangements.Created, analyzed, designed, developed and implemented projects and reports using business object and Careplanner software.Researched system issues, resolved daily operational errors and provided documentation of current operations, user security and interfaces to Diamond and SQL systems.Created and maintained fee schedules, per diem schedules and all pricing arrangements.Analyzed contracts and reconciled according to contractual agreements.Maintained and updated current pricing methodologies. Show less

Claims Trainer/Auditor

• Aug 2000 - Aug 2003

· Developed monthly audit reports and Excel spreadsheets to measure quality and standards. · Audited medical, dental, vision, and hospital claims. · Supported adjudicators with audit error resolution. · Created and implemented policy and procedures manual. · Coordinated benefits and reimbursements with Medicare and other insurance carriers.

Claims Adjudicator II - IV

• Jan 1994 - Aug 2000

Processed medical, dental, vision and hospital claims. Created, received, processed and tracked EDI claims. Supported claims service representatives with payment, non-payment and denial questions from providers and enrollees. Processed medical, dental, vision and hospital claims. Created, received, processed and tracked EDI claims. Supported claims service representatives with payment, non-payment and denial questions from providers and enrollees.