Designers and manufacturers of telescopes, binoculars and other precision optical goods. Dual Custoer Service Support and EDI Specialist role, with some application administration (Kayako). Company utilizes the SAPbyD ERP, supported by iConnect with SPS Commerce as the third party EDI Service provider. 940/945 document set with a Canadian 3pl, on-site warehouse operations. Documents traded include 850, 810, 855, 846, 856. Heavily drop-ship, but bulk ship to DC also supported. Migration of customer portals, EDI implementations, documentation.
- EDI Specialist at Celestron LLC
- EDI Analyst at Kraco Enterprises
- Volunteer Copywriter at Midnight Mission
- EDI Specialist at Kraco Enterprises
10 months at this Job
- Bachelor of Science - Communication Arts
151 Lafayette Dr, Suite 401, Oak Ridge TN 37830 (865) 482-1999 Manager: Jenny Edwards My position as EDI Specialist required me to coordinate between the claims clearinghouse and medical practices across the United States that uses the AllMeds Billing Software. This includes deciphering clearinghouse and payer rejection messages and working with practice billing staff to correct issues and submit clean claims. To accomplish the responsibilities, I used knowledge of ICD10 Coding, and specific payer requirements, in addition to working knowledge of the Electronic Data Interchange (EDI) application and Practice Management software. Crate reports in Excel using pivot tables and graphs for easy understanding by the upper management team.
- EDI Specialist at AllMeds, Specialty Practice Services
- Implementation Specialist at AllMeds, Specialty Practice Services
- Supervisor of the TennCare Appeals Department at United Healthcare
1 year, 3 months at this Job
- - Cosmetology
- - Leadership and Management Skills for Women
- License - Customer Service Skills
As an EDI Specialist my responsibilities include the retrieving and decrypting claims file from the secured FTP site, updating and monitoring claims received log, accounting for all claims received and in-loaded on a daily basis. Generate and submit acknowledgment reports (277u) to the appropriate entity to ensure compliance with AB1455 on a daily basis. I also research errors and rejected claims received and make the necessary corrections and/or report to submitting entity. I work with other teams and outside entities as a liaison for the department and generate, validate and submit claim encounter files in the appropriate ANSI X12 5010 compliant format to the various outside entities via secure FTP site and/or clearinghouse. I currently work on 837P and 837I and 835's for internal and external entities on a weekly basis using EDI notepad and EZcap programs. I also track trending issues with encounter data and suggest corrective actions to comply with EDI encounter submissions.
- EDI Specialist at Rady's Children hospital
- Claims Analyst II at Children's Physicians Medical Group
- Claims Analyst II at Community Health Group
- Claims Specialist III at Regence BS/Cambia Health solutions
2 years, 10 months at this Job
- High school
1000 118 Avenue North, St. Petersburg, Florida, 33716 2012 - Present
Medical Claims Validator
• Research all Medical Claims.
• EDI Specialist
• Louisiana Medicaid
• Trainer - Processing Hicfa's and UB's.
• Approve all Provider and Submitter claims for exact calculation of fees.
• Oversee the claim flow for validators.
• Reject all invalid claims.
• Handle all rejections and update to corporate.
• Communicate with Providers, explaining rejections of claims.
• Prepare EOB's (Explanation of Benefits) for printing.
• Handle all electronic application of claims.
• Prepare 834 from Maximus.
• Prepare EOR's (Explanation of Rejection) for printing.
• Using Revelation software, Work in AREV.
• Provide daily numbers for New Members and Terminations.
• Use Validation Station to validate all medical claims.
• Fix all errors that are not rejections, and re-upload them for processing.
- EDI Specialist at Community Health Solutions
- Credit Collector at Van Ru Credit Corporation
- Dianne Nelson Tax Collector at Starkey Road
- Office Manager at NuShine Bathroom & Kitchen Refinishing
7 years at this Job
EDI Specialist January 2018 to Present
•Submit claims via EDI or mail to jurisdictions inline with state requirements.
•Research and submit subsequent reports to the jurisdictions.
•Provide exceptional customer service to both internal and external contacts:
•Communicate daily with adjusters on needs for EDI submissions.
•Communicate with jurisdictions on various aspects of EDI.
•Work with adjusters on training needs in relation to EDI requirements.
•QA responsibilities ensuring state filings are timely and accurate Call center Lead January 2017 to 2018
• Provide assistance to team leads.
• Assist with other departments
• Train new hires.
• Monitor and observe various customer queues.
• Participate in team focus meetings
• Research and resolve outstanding customer issues
• Assist in operations and policies.
• Provide quality assurance to outstanding customer accounts
- EDI Specialist at CorVel
- Customer Service Representative at Allied Cash Advance
- Tax Preparer/Seasonal at
- Administrative Assistant at
2 years, 9 months at this Job
- - Early Childhood Education/ Nursing
• Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance.
• Excellent working knowledge and understanding of Medicare, Medicaid and commercial insurance contracts.
• Member of AHIMA Synopsis of Achievements Assisted with state regulatory surcharge audit.
• Promoted to United Healthcare Follow up Representative.
• Cross-trained employees of the department in the rules and regulations of the United Healthcare claims system.
• Cross-trained employees on how to billing PT/OT/Speech and Behavioral health claims.
• Promoted to I/O Claims Biller.
• Promoted to EDI Specialist.
• Obtained CCS certification, Reviews billing work-ques and reports to determine accounts/ claims requiring action.
• In accordance with department policies and procedures, performs such actions as resolving billing.
• Claim edits, collaborating with internal and external resources as needed, initiating phone calls and website inquires, and attending payer meetings in order to in process billing processes and claim submissions.
• Reviews assigned rejections and takes timely action to resolve payer requirements.
• Ensures claims are crossed over to secondary and tertiary payers and reports any delays in unbilled claims.
• Is aware of timely filing guidelines for all payers: prioritizes work based on these time lines to ensure claims are submitted timely and financial losses are minimized.
• Interprets Managed Care/ Contracts to understand billing requirements.
• Possesses knowledge of Medicare, Medicaid and other third party regulations to ensure compliant billing and accuracy in system edits.
• Responsible for the daily reconciliation of all billed accounts through payer acceptance.
• Setting up and billing Downgrade bills (Inpatient to Outpatient).
• Adjusting Downgrade bills (Inpatient to Outpatient) according to insurance contract rates.
• Help develop and streamline a quality improvement process with guidelines for proper billing for downgrade accounts.
• Responsible for meeting and/ or exceeding productivity and quality standards as set forth in the department's policies and procedures.
• Collaborates with internal departments, external venders, and IT for issue resolution and operation effectiveness.
• Prepares weekly and monthly reports of unbilled accounts, held claims, clean claim rates by payer, and rejections.
• Conducts analyses and effectively communicates to leadership any internal bottlenecks, delays in payment, and financial risks associated with billing activity.
• Works with the claims system vendor to process operational compliance and performance through system modifications.
• Maintains log of open technical items requiring vender assistance and participates on calls to resolve technical barriers, review system updates, and test any system modifications.
• Working with Cash department (Physician/Hospital) in locating money that posted on the wrong side.
• Having payments transferred to the correct Hospital I/O Claims Biller.
• Reviewing Itemized bills from Managed Care on the breakdown of 131/121 bills.
• Setting up/Splitting claims 131/121 claims to be billed from Inpatient to Outpatient after claims are determined to not meet criteria for Inpatient.
• Correcting claims so claims go out smoothly with no problems.
• Contacting Managed Care if diagnosis, cpts and other various things need to be adding into system so claims can go out.
• Setting up/Splitting claims 131/121 claims to be billed to 2ndry carriers.
• Follow up on claims(Claim status, Reconsiderations/Appeals, account variances).
- EDI Specialist/Medical Biller at Catholic Health Services
17 years, 6 months at this Job
- - Medical Encoding
- - Health Information Management Procedures
- - Pharmacology For Medical Records Personnel
- - Anatomy & Physiology
- - Medical Terminology
- High School Diploma
As the EDI specialist I am responsible for managing the quality, security, and integrity of data shared within and without the company. I provide production support for inbound and outbound EDI documents. Monitor, analyze, and respond to EDI errors. I create and maintain EDI partner relationships and corresponding EDI translation maps in Gentran. I monitor errors received into SAP and correct them as necessary. I maintain documentation as things change or are added to business processes related to my position. I regularly assist users with requests to send them copies of EDI documents or if they require EDI documents to be resent or answer any questions related to the EDI process.
- Lead EDI Specialist at Hirsh Industries
- Information Systems Analyst at Sigler Companies
- Programmer/Analyst at HNI Corporation
- Web Development Intern, CDS Global at CVS
3 years, 5 months at this Job
- Associate Arts degree
• Communicate with customers to accurately and efficiently resolve their issues
• Understand the use of 810, 856, 850, 860, 855, 812 & 824 transactions and how they interact with one another
• Analyze data, test network configurations and troubleshoot customer systems
• Develop new ways to make the Company's product better suited for our customers
• Configure, set up and train new customers with the company software, old and new
• Test new and old trading partner transactions to ensure that all data meet the trading partner requirements
• Test new updates to the company program to ensure 100% functionality before official role out to customers
• Assist customers with creating, sending and fulfilling all outbound documents to ensure the trading partner receives them on time
- EDI SPECIALIST at EDI OPTIONS
- SOFTWARE SUPPORT TECHNICIAN at NEW YORK LIFE INSURANCE
1 year, 8 months at this Job
- BACHELORS OF SCIENCE IN ELECTRICAL ENGINEERING TECHNOLOGY - Mathematics
• Clear 810/880 invoices through EDI
• Work all fatal errors of invoices
• Understand DUNS numbers
• Business Objects reporting
- EDI Specialist at Regional Accounting Service Center
- Procurement Specialist Minor Capital at Kroger Division office
- Associate Manager at Kroger - Promotion
- Assistant Manager to Customer Service Manager at Kroger - Promotion
7 months at this Job
Responsible for the planning, implementation, maintenance, and support of EDI applications and processes.
● Ensure all EDI transactions are processed correctly and timely daily.
● Resolve EDI data discrepancies from internal systems/interfaces and any discrepancies from trading partners.
● Work cross-functionally between Brokerage, Transportation and Warehouse departments to resolve any EDI issues for all supported trading partners.
● Supporting all levels within the company for helpdesk related tasks through phone, remote, and ticketing system.
● Addressing all external and internal user inquiries efficiently and effectively.
● Upgrades and conversions of WMS and TMS systems within the organization.
● Acquiring user feedback to create reports used by ownership, finance, and all other departments as needed.
● Setup and administration of tablets utilizing Maas 360 as an MDM solution and XRS as an ELD solution.
● Supporting drivers in person as well as on the road remotely with technical questions and tablet concerns.
- EDI Specialist at Logistics One Inc
- Onboarding Representative II at CommerceHub
- Accustaff Contractor at Onboarding Representatives
2 years, 1 month at this Job
- Bachelor of Science
- Associates of Applied Science - Applied Science