As a Software Developer III with Modivcare I am an integral member of a diverse Team of technical EDI and support specialists who deliver EDI solutions to our internal as well as our External Clients. My role within this group is varied and flexible where one moment I might be tasked with modelling for import an 834 or Flat file eligibility solution with an interface to import eligibility data into our database and other activities might include solutioning an 837 Encounter process that exports member claim data then parses this information either through our Legacy or Red Point application to bundle up the visits into EDI segments and transactions for submission to our downstream HMO and or State Clients. Since Modivcare is constantly sending and receiving EDI data files from our HMO and State Clients I am also tasked in analyzing 837 rejection data files to either report cause and or recommend remediation solutions. Most recently I am developing 837 Encounter modifications for the State of New York with our Delphi tools and developing a post processing solution to modify the EDI output through our Red Point application to add additional 2430 CAS segments and updating the EDI transactions ST to SE index values.

Area of responsibilities included Vendor validation and Oracle batch configuration of export tables to produce EDI XML generated outbound 834 eligibility files for submission to our downstream Vendors. This also required supporting the file server routing processes to manage and confirm timely submission of the generated 834 eligibility files.Played a role in assisting our Encounters team in a documentation project which involved collating and documenting all State submission guidelines and developer technical documents into a single source share point tool which allowed ease of use and accessibility across the entire end user network. Was responsible for following up on internal email and projects from our Enrollment team when there were eligibility file submission questions, file resubmission requests, new Vendor onboarding and modifications to existing submission processes.Took on the responsibility to development a system where we could easily analyze outbound 837 and 276 claim transactions and compare them to the State inbound 277 transactions to assist our New York call center when managing a member’s eligibility status and answering timely filing reconciliation concerns.

Logisticare is a logistics service broker specializing in providing non-emergency transportation services to Medicaid and Medicare beneficiaries. An integral component in the services provided to our clients is the management and processing of eligibility data followed by timely submission of the electronic encounter data. Another major area where my experience and skills support Logisticare and its clients is in the development and post analysis of the claim encounter data submissions. I am an integral part of their EDI team which is tasked in analyzing new encounter submission requirements, developing and testing encounter submissions with the client and creating post encounter claims handling and re-submission routines. This process begins with a full review of our contracted obligation and deliverable requirements, question and answer sessions with our technical EDI counterparts and a three phased testing process. Once testing is completed the entire process is documented and released to our production team where we follow the production submissions a number months as quality monitors. I am extremely confidant and comfortable communicating with our clients any technical requirement and or concern identified through the initial project startup phase or later in the project through a client’s change request or error on our behalf. Because of the wide range of technical resources our clients employ I am completely comfortable working with a wide assortment of file types from the very large State facility provider files to any of the ANSI ASC x12 file formats, below are some of the common formats I work with,

Supporting company with data mining processes and developing lead generation data to generate new business leads and contribute in part with the proposal writing team to prepare RFP’s and RFQ’s.Supported and developed HIPPA compliant in-house document imaging process to capture and store all received patient, practice and payer communication resources. Supported teams by provide technical training, documentation and support materials for workflow diversification. Configured and maintained new providers billing data in our database to allow our billing servers to either bill direct to a State or to a clearinghouse. Also responsible for triaging and resolving electronic claim billing technical issues as they arise from our multiple EDI communication connections and destinations.Developed database translation processes to meet Client data submission requirements with tools like VB Pro and VBA applications. These projects supported our client’s data requests for formatted reports and data file dumps to be reviewed and analyzed during monthly revenue cycles. I provided many products such as, custom coding solutions, coding a data translation export map or interfacing with the clients vendors to design a solution specific to their the billing requirement and or system requirements. I maintained our in-house production workstations, production servers and production processes and assisted if necessary with our clients computer maintenance needs when it impacts their ability to perform necessary functions with our software.Maintained an ongoing working relationship with our clients IT staffs to respond to any data and or communications concerns such as, import file errors, billing data deliverable errors, and or FTP connectivity failures.Maintaining an ongoing business relationship with all key business partners to support our business model such as, GRU data, AT&T voice, Expressbill, PSC, Emdeon, Sage, Sequelmed, CFO Billworx, SSI, Atlantic.net.