Robyn DiLauro

2531 Anani Road

Henderson, NV  84099

 

702-860-1348

dilaurowstjrdn@aol.com

 

 

PROFESSIONAL SUMMARY:

Ø       Data analysis, quality assurance, documentation, training and reporting process improvement, reviewing business requirements, in the Information Technology arena.

Ø       Demonstrated experience in HIPAA ASC X12 Electronic Data Interchange Standards (EDI), 834, 835, 837, 270, 864 and 997Established proficiency in database design and reporting using SQL Languages and Access.

Ø       Ability to manage multiple projects meeting fixed deadlines.

Ø       Excellent communication skills.

 

EDUCATION AND PROFESSIONAL CERTIFICATIONS:

·        Certificate of Graduation in Business – Salt Lake Community College

·        Certification – EDI International Association of Industrial Accident Boards and Commission

·        Certification – Ingenix Certified Trainer

·        Certificate of Completion – Microsoft ACCESS 2003 (Beginning, Intermediate, and Advanced)

TECHNICAL SKILLS:
Platforms: Microsoft Windows 7, AS400, Unix

Software: MS Office Suite 2010 (ACCESS, Word, Excel, MS Project, Outlook, SQL) Lotus Notes, Interact Tracking System, JIRA, File Transfer Protocol software.  Medical Bill Review software including; ProClaim, ACT, Amisys, PowerTrak, Central Medicare Claims System (CMS), AmeRx, Blue Cross Blue Shield processing systems, CBAS and UHINet Web Service, Pervasive Mapping Program

Hardware: PC workstations, Fax and copier

Other: Oracle Database Tables, Provider Center Web Application set-up, Mainframe database, Quality Assurance, Query Development,  PS SQL, Excel and ACCESS reporting, Extensible Markup Language (XML)

 

PROFESSIONAL EXPERIENCE:

 

HMS Holding Corporation – 10/2013 to 03/2014

Data Analyst

·   Worked on project to map client certification to HMS Database utilizing Access and Excel.

 

Ceridian Corporation – 3/12/2012 to 05/2013

Data Analyst Specialist 

·   Work closely with Project Manager and Carriers, analyzing and interpreting data requirements, mapping Health and Welfare information and sample files using Oracle SQL queries to verify and load Medical eligibility data files into User systems.

·   Create and maintained Export interfaces from the H&W benefits platform

Key Accomplishments:

·   Utilizing expertise in Medical Claims Data processing, completed changes and  promotion of  2013 Annual 834 EDI Enrollment data files for 7 Clients.  Completed interpreting system specifications converting 60 Carrier specifications translating the data into new claims system requirement.

 

HCI – 3/20/2012 to 12/20/2012

Contractor - Medical claim data EDI ETL specialist 

·   Acted as liaison between the business units and technology teams reviewing data requirements, mapped claims information and sample files using Oracle SQL queries to verify and load Medical Claims data into useable Oracle tables.  

·  Imported data from Oracle data tables into Microsoft Excel 2010, producing Data Quality pivot table reports for management review.

Key Accomplishments:

·  Utilizing expertise in Medical Claims Data processing, completed project interpreting system specifications converting 18 client’s specifications translating the data into new claims system requirement.

 

CBIZ National Business Alliance03/2010 – 03/2011

Business Benefit Data Analyst

•   Process and monitor all inbound and outbound 834 and custom medical benefit file feeds.
•   Perform, monitor and track the daily processing of electronic data files using excel spreadsheets to calculate data results.
•   Using client specifications, imported client benefit data into Excel to analyze data writing macro’s to streamline process.
•   Work with trading partners to resolve any operational issues based on discrepancy reports.

Key Accomplishments:

·   Utilizing Microsoft ACCESS I designed tables, data entry screens and SQL query reports used by departments for file feed tracking.

•   Developed processes to resolve discrepancy report results for all EDI transactions 

 

Regence Blue Cross Blue Shield/Noridian06/2004 -6/2007 and 06/2009–11/2009
Senior EDI Business Data Analyst, Data Analyst Specialist

·   Performed transaction management and EDI business processes with vendors, providers and trading partners to ensure compliance with system changes. Recommended, based upon test results, approval of provider’s submission of Electronic Medical Claims in ANSI X12 format. Identified unusual electronic medical claims transmissions 834, 835, 837, 270, 864 and 997 and established corrective action plans to ensure timely processing for claims payment using National Electronic Data Interchange standards.

·   Performed system testing for new Trading Partner EDI file submissions using excel to filter, calculate and produce pivot table reports.

·   Conducted second line EDI claims compliance troubleshooting with providers, vendors and clearinghouses and researched and solved software and data problems providing corrective actions.

Key Accomplishments:

· Responsible for the transition and maintenance for all trading partners to the 4010 EDI file standards for claim submission and electronic funds transfer for Medicare claims.

· Set-up State of Utah, Idaho and Washington Trading Partners (providers) for utilization of a new web based application used to view eligibility, claims and certification on-line.

 

RxAmerica 04/2008 – 06/2009

QA Quality Analyst, Training Specialist

·Designed ACCESS SQL queries from the ODBC database tables for the development of automated processes Benefit Coder system configuration.

·Developed comprehensive documentation using PowerPoint, Microsoft Word and WebX software used to present classroom instruction.  Conducted training sessions for Benefit Coders on how to utilize and write simple SQL queries and use of AmerX software.  Provided instruction on use of ACCESS database queries to load data systematically.

Key Accomplishments:

·Played key role in enhancing usability of development test tools using SQL, excel to report results.

·Instrumental in developing guidelines, excel spreadsheet checklists and processes and procedures for the QA review of system benefit configuration.

 

Convergys Outsourcing 10/2007 – 04/2008

Knowledge Base Administrator

·Developed and documented business processes in accordance with management and client direction.

·Identified, determined and scheduled reporting needs for both Convergys Management and the client.

·Converted business and client requirements into actionable Answer Station tasks and configuration.

·Implemented client and business requests.

·Tested current and new design implementations against business goals and accuracy.

Key Accomplishments:

·Developed new knowledge base templates to provide call center agents’ consistent level of service.

·Collaborated with client to produce documentation using Microsoft Word.

·Wrote and posted daily announcements of changes to processes, promotions and product recalls.

 

Ingenix, Inc 10/1999 – 06/2005

Senior Business Analyst, EDI Reporting Specialist

·Utilized ACCESS and SQL to convert data into tracking reports and system loads. Responsible for researching all pricing and medical coding changes posted at State and Federal Medicare Part A and Part B for Fee schedules and pricing rules.

·Converted fee schedules, reporting specifications and HCFA 837 standards to ensure proper adjudication of claims.

·Analyzed client’s specifications, developed business plans to program specifications and ensure completion of projects. Provided technical staff project plans, schedules and system issues.

·Conducted training sessions on proper processing of State Reports within the PowerTrack Worker’s Compensation claims processing software.

Key Accomplishments:

·   Utilizing Microsoft ACCESS I designed tables, data entry screens and SQL query reports used by department of 15 for data input tracking.

·   Wrote specifications and processes and system mapping for development of a provider pricing data file transfer to contracted clients.

·   Responsible for research and submission of change requests to the development team for all 837 Electronic Medical Claims ANSI X12 (EDI) format changes in PowerTrak software.