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Dantrese
Dantresecodes@gmail.com
772-216-9958
Fort Pierce, FL 34988
EDI Analyst
13 years experience W2
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Average rating
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Summary

  • I am an EDI Analyst and Certified ScrumMaster possessing over 5 years of experience with HIPAA standards and code sets, healthcare EDI transactions (820, 834,835,837, etc), claims processing, medical coding, ETL testing and mapping as a remote and onsite resource.

EDUCATION

  • 2013 MBA, Marketing
  • Nova Southeastern University
  • 2009 B.S. Economics
  • University of Florida
  • 2018 AAPC
  • Certified Professional Coder (CPC)
  • Certified Professional Biller (CPB)
  • Certified Anesthesia and Pain Management Coder (CANPC)
  • Certified Risk Coder (CRC)
  • Certified Professional Medical Auditor (CPMA)
  • 2020 Scrum Alliance
  • Certified ScrumMaster (CSM)

KEY SKILLS —

  • SQL (Relational Databases)
  • ETL (Extract, Transform, Load)
  • Data warehouse management
  • Data Aggregation
  • EDI Mapping
  • EDI files (834, 820, 270, 271, 837, 276, 277, 835, 278, 999)
  • XML, HL7
  • Companion Guide
  • HTML, CSS, Bootstrap
  • QA-Automation testing
  • Medical Billing and Coding
  • Knowledge of Agile Methodologies

Experience
EDI Analyst
Information Technology
Mar 2019 - Jan 2020
Boston, MA
  • Examined initial test files for structural compliance and data quality using companion guides
  • Performed scenario testing on 834 transaction sets for additions, changes, and terminations
  • Gathered requirements on facets interfaces for benefit enrollment and maintenance subsystems
  • Performed technical analysis for 834 (v.4010 to 5010) version control
  • Participated in the enrollment reconciliation process to resolve data discrepancies with trading partners
  • Tested daily claims processing and uploaded 837 and 835 files into the database
  • Mapped and translated various data segments using Altova
834 837 Compliance EDI EDI Analyst
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EDI/ETL Analyst
Information Technology
Jul 2017 - Mar 2019
Atlanta, GA
  • Validated Data via 837 files and updated profiles with eligibility and enrollment
  • Performed file tracking for all trading partners sending x 12, XML and flat files
  • Mapped and translated various data segments using Edifecs
  • Tested and completed ETL mappings (data warehouse testing)
  • Collected data from various sources, transformed data in accordance to project guidelines and loaded it into destination data warehouse with SSIS
  • Utilized data normalization forms to improve storage efficiency, data integrity and scalability
  • Used MS SQL (DDL-Data Definition Language, DML-Data Manipulation Language and DQL-Data Query Language) commands to maintain databases
837 Data Integrity Data Warehousing EDI ETL SQL SSIS Edifecs
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EDI Analyst
Information Technology
Apr 2014 - Dec 2015
Chicago, IL
  • Responsible for supporting all phases of SLDC as a member of the implementation team, to include spec (companion guide) build
  • Mapped and translated various data segments using Edifecs
  • Converted historical clinical data by interfacing and capturing transactions from legacy systems (HL7 and X12
  • Configured existing system with facets for group eligibility and claims compliance checks
  • Utilized Selenium for automation testing and QA HCC Risk Adjustment Coder
Compliance EDI EDI Analyst Selenium Edifecs
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HCC Risk Adjustment Coder
Medical Devices
Apr 2014 - Dec 2015
Minnetonka, MN
  • Assigned and report all HCC Risk Adjustable diagnoses and services accurately and completely
  • Maintained chart completion and accuracy rate of 98%
  • Reviewed information from medical records, operative notes, and consults to ensure precise documentation
  • Managed system conversion and maintained minimal downtime during updates
  • Researched and compiled statistical data to support cost control and care improvement initiatives
  • Resourcefully used various coding books, procedure manuals and on-line encoders
  • Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement
No skills were added
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Revenue Cycle Analyst/Trainer
Medical Devices
Sep 2012 - Apr 2014
Sacramento, CA
  • Provided coding (CPT, ICD-10, HCPCS, HCC Risk Adjustment) and documentation support for Epic revenue cycle modules to end-users
  • Analyzed departmental workflows and documentation improvement opportunities
  • Audited charts for accurate documentation and coded for correct chronic conditions (HCC) and procedure codes
  • Conducted Phase I and II meetings for documentation improvement implementation practices
  • Trained end-users on applications to ensure proficient navigation with medical coding, charge capture, charge-related work queues, and charge reconciliation
  • Provided in-class support for Super Users, Revenue Cycle Point Persons, and Clinical Managers Liaison between departmental leadership and the build team for workflow optimization
No skills were added
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B.S. Economics
Information Technology
Jan 2009 - Jan 2009
No skills were added
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Edit Skills
Non-cloudteam Skill
Education
Bachelor's in Economics
University of Florida
Certifications
Certified ScrumMaster possessing over 5 years of experience with HIPAA standards
Skills
EDI
2020
4
Edifecs
2019
3
837
2020
2
Compliance
2020
2
EDI Analyst
2020
2
Data Integrity
2019
1
Data Warehousing
2019
1
ETL
2019
1
Selenium
2015
1
SQL
2019
1
SSIS
2019
1
834
2020
1
HIPAA
0
1