Eric Polinsky Email & Phone Number

Fernandina Beach, FL, US

Hartford, Connecticut, US

Plymouth Meeting, PA, US

Billing integrity system creation and payor EDI management

Aurora, Colorado, US

• Created, optimized, and maintained all.x12 EDI systems between the State of Colorado (HCPF) and QNXT hosted environment used by COA. Main business objects were Membership (834), Claims (837), and Payments (820)
• Created training modules and instructed several COA departments on QNXT technical items customized to their needs.
• Created several internal solutions for various business purposes: CARC/RARC, Claims Dashboard, EDW interfaces,.x12 interfaces, and QNXT plandata and planintegration reporting
• Trained software development team members on COA tools and business solutions
• Created internal process documentation to promote and maintain systems
• Estimated time and tasks for new project requests

Madison, WI, US

• Provided business and technical EDI support for a new Medicare line of business using QNXT 5.2.
• Managed project deliverables, leading meetings, and delivering QNXT EDI export solutions focusing on 835 and other provider payment transactions
• Consulted on several other EDI.x12 transaction sets (837, 270, 271, 276, 277)
• Guided technical team on how to use QXI SOAP calls
• Trained both business and technical teams on QNXT databases/tables, BizTalk Event Viewer, QConnect, QNXT UI Payment Manger, and QNXT UI EDI Manager
• Created specialized reports from QNXT PlanData and PlanIntegration using SQL Server Management Studio 2012

Chula Vista, California, US

• Fixed and enhanced EDI Membership Preprocessor add-in logic to import membership related files (834 and DTRR). Logic focused on properly updating enrollment related tables in QNXT 5.1, as well as government related.
• Provided detailed analysis of current membership data and processes to drive business requirements
• Created technical requirements for the updated Preprocessor
• Mentored development team to properly code new Preprocessor requirements
• Performed unit testing on new Preprocessor logic
• Created several ad-hoc reports from QNXT PlanIntegration, QNXT Plandata, and in-house preprocessor tables

Greenwood Village, Colorado, US

Helped payers implement and integrate QNXT into existing systems.

Miami, Florida, US

Created 837 test claim files and used QNXT Connect to help determine proper QNXT configurationCompleted research on QNXT Connect log tables focused on claim importationCreated executive summaries and presented directly to CIOCreated 837 institutional and professional companion guides used by providers sending Medicaid claim data Created business and.

Miami, FL, US

Day to day production critical issue resolution - X12 Claim data (837)- X12 Member data (834)- Worked with team to fix other related critical production QNXT anomaliesTeam Subject Matter Expert for QNXT and Plan Data- Core team member to configure and implement QNXT at ILS, and integrate into local ILS systems and vendors- Answered questions from team.

Rockledge, Florida, US

Provided X12 EDI, reporting and database expertise for Medicaid businessGained experience in AMISYS Advance 5.0 UI and database structureCreated design documentation for several Medicaid subsystems: - Electronic Remittance Voucher (ERV) Reconciliation - Payment (820) Reconciliation- Enrollment (834) file processing- Claim (837) file processingCreated.

Marshfield, WI, US

• Led business and technical meetings to create and gain final approval for requirements in the fol-lowing system areas:o 5010 X12 EDI interfaces: 834, 835, 837, 820, 270/271, 276/277o Hard Copy Claimso Proprietary.
• Used QNXT 4.8 UI and databases
• Performed analysis on legacy and QNXT systems by:o reviewing 4010 and 5010 X12 data using implementation and companion guideso configuring the QNXT EDI Manager Utility for all trading partnerso examining the QNXT.
• Created test cases and test data for 5010 X12 interface units, and proprietary membership files
• Facilitated testing of pre and post QNXT Connect add-in code by creating appropriate claims from the UI, adjudicating, paying, creating checks, and running appropriate export processes
• Created detailed reports of X12 EDI data imported and exported by both legacy and QNXT systems at the element level to find possible HIPAA compliance issues, and to flag any gaps between systems

Honolulu, Hawaii, US

• Led business user meetings to create scope, requirement, and design documentation for several QNXT interface projects
• Worked with most QNXT interface systems including 837 Claim Routing, 835 Remittance, payment, ARGUS Drug Claim Processing, EFT to Provider, Reports to Members and Providers, Check Sta-tus, and 834 Membership
• Defined, analyzed, designed, created, tested and maintained several systems to interface with QNXT health care management software
• Worked with QNXT 4.7 to troubleshoot membership anomalies
• Managed development team located in India assuring requirements were communicated correctly, and that software solutions are delivered on time
• Performed cost benefit research on membership projects to determine ease of data portability into current membership systems and how to potentially remove the need for third party software

Greenwood Village, CO, US

Chicago, Illinois, US

Houston, Texas, US

Bs, Computer Science, Psychology

Mba, International Business