Self Employed EDI Consultant 4/2017- current- Mapped and tested files for testing. - SQL scripts / queries and testing- Worked with end users establish UAT test scenarios - Tested with plans for CMS required MOOP 837 files Error corrections- Work with other departments to reduce the amount of (what kind of errors) errors - Kept current with 837, HIPAA news and applied it as needed - Managed several projects (what kind of projects?) at the same time- Went… Show more Self Employed EDI Consultant 4/2017- current- Mapped and tested files for testing. - SQL scripts / queries and testing- Worked with end users establish UAT test scenarios - Tested with plans for CMS required MOOP 837 files Error corrections- Work with other departments to reduce the amount of (what kind of errors) errors - Kept current with 837, HIPAA news and applied it as needed - Managed several projects (what kind of projects?) at the same time- Went to client sites to resolve issues- Managed the scope and timelines per the client’s requirements and responsible for delivering projects on time- Sal Spina sal@care4hc.com 510-270-2966 Show less

Environment: MS Access, MS Excel, MS Project, HIPAA, FTP pro, Ultra edit, Claredi, SQL scripts / queries/testing I was the EDI department alone, I put myself on a schedule as to when I wanted files to be ready for submission. When I started in this position all files where going through a clearinghouse which was causing errors, I decided to submit directly to the health plans so I gathered information from each plan for propriety information that was required, I did all the mapping, testing… Show more Environment: MS Access, MS Excel, MS Project, HIPAA, FTP pro, Ultra edit, Claredi, SQL scripts / queries/testing I was the EDI department alone, I put myself on a schedule as to when I wanted files to be ready for submission. When I started in this position all files where going through a clearinghouse which was causing errors, I decided to submit directly to the health plans so I gathered information from each plan for propriety information that was required, I did all the mapping, testing until a file was ready to be submitted for testing. Once that was done I was moved to production by the plan, our compliance went up and errors went down. I was able to get all my submissions complete by the first of the month so I would have time to work on other projects• Created maps for each Health Plan and LOB• Test 837 files with Health plans so we can do direct submissions, using Claredi• Used EZ-Cap create trading partners, create profiles for each TP• Extracted monthly files for submissions of 5010 files• Automate extractions for monthly submissions• Communicate with X12, WEDI and ICE for new information on 5010 and all standards• Resolve client issues with mapping and X12 education• Tested with plans for CMS required MOOP 837 files• Reconciliation to make sure all data had been extracted and at all levels and make sure Health Plan received all data • Work with other departments to reduce the amount of errors• Kept current with 837, HIPAA news and applied it as needed• Used MS Excel to track submissions• Worked with MS Access for error, and other tracking• Wrote test plans, test cases, UAT testing and test scenarios• SQL scripts / queries/testing • Managed several projects, same time• In charge of training • Responsible for implementation of EZ-cap 5x to 6X experience• Managed the scope and timelines per the client’s requirements and responsible for delivering projects on time Show less

Environment: MS Access, MS Excel, MS Project, HIPAA, FTP pro, Ultra edit, Claredi• Verified and corrected files formats 837 P I 835 • Restored ERA files• Helpdesk hotline• Reprocess EDI 837 files, test using Claredi

Contract position ended. Kaiser was a great place to work

CREATED 4010/5010 GUIDES FOR ALL TRANSACTIONS 5010 TESTING PROCESS FILES ALL TRANSACTIONS THROUGH CLAREDI AND REPORT ERRORS TO CLIENTS INSTRUCT PROVIDERS ON 837 P & 837I FORMATS AND CLAREDI ERRORS SUGGEST BUSINESS SOLUTIONS TO SATIFY HIPAA REQUIREMENTS. COMMUNICATE WITH X12 AND ICE FOR NEW INFORMATION ON 5010 AND ALL STANDARDS RESOLVE CLIENT ISSUES WITH MAPPING AND X12 EDUCATION CREATE MAPS FOR 837, 834, 835 INBOUND AND OUTBOUND FORMATS… Show more CREATED 4010/5010 GUIDES FOR ALL TRANSACTIONS 5010 TESTING PROCESS FILES ALL TRANSACTIONS THROUGH CLAREDI AND REPORT ERRORS TO CLIENTS INSTRUCT PROVIDERS ON 837 P & 837I FORMATS AND CLAREDI ERRORS SUGGEST BUSINESS SOLUTIONS TO SATIFY HIPAA REQUIREMENTS. COMMUNICATE WITH X12 AND ICE FOR NEW INFORMATION ON 5010 AND ALL STANDARDS RESOLVE CLIENT ISSUES WITH MAPPING AND X12 EDUCATION CREATE MAPS FOR 837, 834, 835 INBOUND AND OUTBOUND FORMATS IN ACCORDANCE WITH HEALTH PLAN GUIDES. CREATE CUSTOM MAPS FOR BLUE SHIELD, HEALTH NET, CAL OPTIMA, MOLINA, CARE1ST , EZ-CHOICE AND SCFHP ACCORDING TO THEIR GUIDES Ability to work both independently and in team-oriented environment ICE TEAM MEMBER HIPAA TASK FORCE. KEEP UP ON CMS CHANGES AND ALERT THE APPROPIATE STAFF. Comprehensive knowledge of professional (1500) and institutional (UB92/ UB04) billing forms, knowledge of CPT, HCPCS and ICD9 codes. Analyze information and situations to determine possible future issues and report resolutions and recommendations to the team for solutions. Advise development team on issues with maps that need to be changed. Lead on-site client sessions for EDI/ HIPAA training and resolutions to EDI issues Show less

ENVIRONMENT: MS ACCESS, MS EXCEL, MS PROJECT, ABS, HIPAA, FTP PRO, ULTRA EDIT, CLAREDI VERIFY ACCURACY OF X12 HIPAA TRANSACTIONS PROCESS 837, 834 TEST FILES, NPI AND ACCURACY ANALYZE 837 TEST DATA FROM PROVIDERS RUN TEST FILES THROUGH CLAREDI INSTRUCT PROVIDERS ON 837 P & I FORMATS AND CLAREDI ERRORS GATHER USER REQUIREMENTS, MAKE RECCOMENDATIONS FOR SYSTEM CHANGES.  DEMONSTRATED BUSINESS SOLUTIONS TO SATIFY HIPAA REQUIREMENTS.  VERIFY 834 X12… Show more ENVIRONMENT: MS ACCESS, MS EXCEL, MS PROJECT, ABS, HIPAA, FTP PRO, ULTRA EDIT, CLAREDI VERIFY ACCURACY OF X12 HIPAA TRANSACTIONS PROCESS 837, 834 TEST FILES, NPI AND ACCURACY ANALYZE 837 TEST DATA FROM PROVIDERS RUN TEST FILES THROUGH CLAREDI INSTRUCT PROVIDERS ON 837 P & I FORMATS AND CLAREDI ERRORS GATHER USER REQUIREMENTS, MAKE RECCOMENDATIONS FOR SYSTEM CHANGES.  DEMONSTRATED BUSINESS SOLUTIONS TO SATIFY HIPAA REQUIREMENTS.  VERIFY 834 X12 HIPPA PRODUCTION FILES AND MAKE CORRECTIONS TO THE FILE TO PASS CLAREDI REQUIREMENTS. KEEP UP ON CMS CHANGES AND ALERT THE APPROPIATE STAFF.  CREATE MAPS FOR 837 FORMAT WITH ALL THE X12 SEGMENTS SO WE CAN MAKE SURE WE ARE PASSING ALL THE INFORMATION TO OUR ABS AND MACESS SYSTEMS.  ASSIST PROVIDERS WITH CLAIMS AND X12 FORMATS Ability to work both independently and in team-oriented environment ICE TEAM MEMBER HIPAA TASK FORCE. LEAD ON ICE ENCRYPTION TEAM KEEP UP ON CMS CHANGES AND ALERT THE APPROPIATE STAFF.  Comprehensive knowledge of professional (1500) and institutional (UB92) billing forms, knowledge of CPT, HCPCS and ICD9 codes.  Analyze information and situations to determine possible future issues and report resolutions and recommendations to the team for solutions. Show less

ENVIRONMENT: MS ACCESS, MS EXCEL, MS PROJECT, CRYSTAL REPORTS, HIPAA, FTP PRO, AS400, TSOA, IMSP, VISUAL BASIC SCRIPTS VERIFY ACCURACY OF X12 HIPAA TRANSACTIONS VERIFY PROVIDER AND CLAIM INFORMATION IN WGS 2.0 AND STAR PROCESS 837 TEST FILES ANALYZE 837 TEST DATA FROM PROVIDERS RUN TEST FILES THROUGH CLAREDI INSTRUCT PROVIDERS ON 837 P &837 I FORMATS AND CLAREDI ERRORS GATHER USER REQUIREMENTS, MAKE RECCOMENDATIONS FOR SYSTEM CHANGES.  CAME UP WITH… Show more ENVIRONMENT: MS ACCESS, MS EXCEL, MS PROJECT, CRYSTAL REPORTS, HIPAA, FTP PRO, AS400, TSOA, IMSP, VISUAL BASIC SCRIPTS VERIFY ACCURACY OF X12 HIPAA TRANSACTIONS VERIFY PROVIDER AND CLAIM INFORMATION IN WGS 2.0 AND STAR PROCESS 837 TEST FILES ANALYZE 837 TEST DATA FROM PROVIDERS RUN TEST FILES THROUGH CLAREDI INSTRUCT PROVIDERS ON 837 P &837 I FORMATS AND CLAREDI ERRORS GATHER USER REQUIREMENTS, MAKE RECCOMENDATIONS FOR SYSTEM CHANGES.  CAME UP WITH BUSINESS SOLUTIONS TO SATIFY HIPAA REQUIREMENTS.  VERIFY 834 X12 HIPPA PRODUCTION FILES FOR PROVIDERS KEEP UP ON CMS CHANGES AND ALERT THE APPROPIATE STAFF.  PROCESS ENROLLMENTS FOR 837 CLAIMS AND ERA/EFT. VALIDATE PROVIDER INFORMATION IN THE MAINFRAME TO PROCESS ENROLLMENTS ASSIST PROVIDERS IN A HELPDESK ENVIRONMENT WITH CLAIMS AND X12 FORMATS CREATE MONTHLY ENCOUNTER REPORT TRACK ENCOUNTER COUNTS Show less

ENVIRONMENT: MHC, MS EXCEL, HIPAA, MS ACCESS, CLAREDI, UB92, NSF,EC MAP , FTP PRO CREATE HIPAA TRANSACTION COMPANION GUIDES AND VERIFY ACCURACY X12 HIPAA TRANSACTIONS PROCESS 837 PRODUCTION FILES ANALYZE 837 TEST DATA FROM PROVIDERS RUN TEST FILES THROUGH CLAREDI INSTRUCT PROVIDERS ON 837 P & I FORMATS AND CLAREDI ERRORS GATHER USER REQUIREMENTS, MAKE RECCOMENDATIONS FOR SYSTEM CHANGES.  PROCESS FILES USING EC MAP TO TRANSLATE INTO A FLAT FILE THAT I CAN… Show more ENVIRONMENT: MHC, MS EXCEL, HIPAA, MS ACCESS, CLAREDI, UB92, NSF,EC MAP , FTP PRO CREATE HIPAA TRANSACTION COMPANION GUIDES AND VERIFY ACCURACY X12 HIPAA TRANSACTIONS PROCESS 837 PRODUCTION FILES ANALYZE 837 TEST DATA FROM PROVIDERS RUN TEST FILES THROUGH CLAREDI INSTRUCT PROVIDERS ON 837 P & I FORMATS AND CLAREDI ERRORS GATHER USER REQUIREMENTS, MAKE RECCOMENDATIONS FOR SYSTEM CHANGES.  PROCESS FILES USING EC MAP TO TRANSLATE INTO A FLAT FILE THAT I CAN UPLOAD INTO MHC OUR BILLING SOFTWARE. ANALYZE MHC PROBLEMS AND CREATE SOLUTIONS. COME UP WITH BUSINESS SOLUTIONS TO SATIFY HIPAA REQUIREMENTS.  PROCESS 834 MONTHLY PRODUCTION FILES CREATE AND PROCESS 837 TEST DATA TO AHCCCS CREATE MEMOS TO INFORM STAFF OF HIPAA UPDATES. ICE TEAM MEMBER HIPAA TASK FORCE. LEAD ON ICE ENCRYPTION TEAM/ KEEP UP ON CMS CHANGES AND ALERT THE APPROPIATE STAFF.  Comprehensive knowledge of professional (1500) and institutional (UB92) billing forms, knowledge of CPT, HCPCS and ICD9 codes.  Analyze information and situations to determine possible future issues and report resolutions and recommendations to the team for solutions. Show less