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Dantrese
Dantresecodes@gmail.com
772-216-9958
Fort Pierce, FL 34988
EDI Analyst
14 years experience
W2
0
Recommendations
Average rating
44
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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
Remove Skill
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
Remove Skill
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
Remove Skill
Edit Skills
Non-cloudteam Skill
Education
Bachelor's in Economics
University of Florida
Record has not been verified.
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