EDI Analyst I - First Coast Service Options, Inc. - Jacksonville, FL
(2014-11)
Provide analytical and technical support to Medicare providers, vendors, and clearinghouses through the Electronic Data Interchange (EDI) Help Desk.
- Review and validate incoming Direct Data Entry (DDE) enrollment request for Medicare providers, ensuring accurate user provisioning, enrollment tracking and timely system access.
- Prepare and process Administrative Simplification Compliance Act (ASCA) monthly and quarterly reports for leadership review.
- Mentor provider offices, trading partners, clearinghouses, and billing services on EDI issues and resolution strategies.
- Identify, analyze, and report system issues related to EDI products, including PC-Ace Pro 32, PC Print, Electronic Remittance Advice (ERA), and ANSI ASC X12 transactions (837P, 837I, 835, 270/271, 276/277).
- Analyze Medicare FISS/MCS and related claims systems to assess provider data quality and regulatory compliance with HIPPA and CMS Standards.
Operations Analyst III - First Coast Service Options, Inc. - Jacksonville, FL
(2005-09 - 2014-11)
- Led high-performing teams and conducted quality audits to support compliance, ethics, and integrity in alignment with CMS regulatory requirements.
- Reported, managed, and analyzed operational data to support business requirements and executive decision-making.
- Participated in senior-level meetings, providing strategic input and recommendations to leadership and client stakeholders.
- Conducted root cause analysis to resolve client issues and improve business processes through data interpretation and trend analysis.
- Supported testing initiatives for client service conversions and implementation of new audits and system edits.
- Mentored new Operations Analysts on departmental policies, procedures, and core applications to support effective performance and compliance.
- Researched and analyzed written and verbal requests related to Medicare Part A and B fraud investigations.
- Developed Standard Operating Procedures (SOPs) based on federal regulations and Joint Operating Agreements (JOA).
- Generated and delivered monthly savings reports to the Zone Program Integrity Contractor (ZPIC) for CMS tracking.
- Assisted with the transition from ICD-9 to ICD-10 coding systems.
- Served as a subject matter expert on process flow changes between First Coast Service Operations and ZPIC.
Senior Collection Specialist - Blue Cross Blue Shield of Florida - Jacksonville, FL
(2003-01 - 2005-09)
- Led a high-performing team and conducted financial audits to ensure Medicare compliance with federal regulations.
- Researched and analyzed written and telephone inquiries from Medicare providers to recover funds owed to the Medicare program.
- Developed Standard Operating Procedures (SOPs) in accordance with CMS regulations.
- Analyzed, documented, and reconciled financial data for provider enrollment and CMS reporting.
- Prepared quarterly cost-savings reports for the Accounts Receivable department.
- Educated Medicare providers, attorneys, and consultants on federal laws governing the Medicare program through written and verbal communication.
