Dawn Santos
Coventry,RI
Summary
- 36 Years of Healthcare Experience in Electronic Healthcare Formats
- Senior Support Analyst, Analyst, Consultant Tester/Mentor, Team Lead, Subject Matter Expert
- Experienced Electronic Data Interchange (EDI) professional dedicated to implementing and maintaining trading partner relationships and formats for electronic claims, remittance advice, claims status, eligibility requests as well as group enrollment and changes.
- Proven ability to leverage technology to achieve organizational objectives.
- Innovative problem solver whose areas of expertise include HIPAA 837, 276, 270, 278, 834, 835, 820 in the Healthcare market.
- Software integration, regulatory compliance, interoperability, standardization and optimization. Blue Exchange Transactions with BCBSA- 27x & 835, as well as Federal Employee Programs Releases and ITS releases.
Overview
36
36
years of professional experience
1
1
Certification
Work History
Software Dev Advisor
NTT DATA Services, Inc. | Healthcare Consulting Group
11.2016 - Current
- Provided technical support and training to staff on EDI systems, processes and procedures.
- Developed user acceptance test scenarios based on functional specifications provided by clients.
- Created detailed documentation outlining the process flow of each EDI transaction.
- Performed system testing for all EDI transactions prior to implementation.
- Troubleshot issue resolution problems encountered during production runs by investigating source code changes, database table updates.
- Assisted in developing business requirements for new projects related to Electronic Data Interchange.
- Analyzed incoming data files to identify issues or errors related to the mapping of data elements.
- Developed EDI solutions for various trading partners using industry standards such as X12, EDIFACT and XML.
- Monitored records and files transmissions to customers to ensure smooth and error-free deliveries.
- Developed and strengthened business partner and customer relationships.
Software Dev Advisor
Dell
03.2016 - 11.2016
- See section above.
Senior Support Analyst
Blue Cross Blue Shield of Rhode Island
Providence, RI
01.1988 - 03.2016
- Analyzed data from multiple sources to identify trends or patterns that could indicate potential problems.
- Performed root cause analysis on transmission issues.
- Developed and strengthened business partner and customer relationships.
- Built, maintained and troubleshot electronic data interchange customer maps.
- Monitored records and files transmissions to customers to ensure smooth and error-free deliveries.
- Participated in cross-functional team meetings to provide input into development strategies.
- Developed EDI solutions for various trading partners using industry standards such as X12, EDIFACT and XML.
- Analyzed incoming data files to identify issues or errors related to the mapping of data elements.
Education
Bachelor of Science - Marketing
University of Rhode Island
Kingston05-1987
Skills
- Plan, Implement and Lead Electronic Data Interchange (EDI) initiatives from internal and external parties, review rules and regulations, contracts and organizational directives
- Maintain security protocol with Trading partners, updating Tradelink’s and transactions in ITXA software, assign Realtime API user-ids and passwords for Realtime API
- Manage relationships with Trading Partners by executing agreements, scheduling tests, evaluating test results and scheduling production implementation
- Monitor claims rejection trends and act on issues when needed
- Open request tasks and Incidents as needed
- Monitor and work to continuously improve service level performance from vendors and other entities (process improvement) 837, 835, 27x, 834, 820, Federal Employee Program outbound 837’s
- Provide EDI Testing support and guidance
- Mentor less experienced staff, testers, team members/coworkers/business staff
- Support other departments and offshore testing team adhoc
- I2L – Introduction to Leadership training @NTTDATA, ITIL 4 certification
- Problem analysis and resolution, recognizing trends
State
RI
Zip
02816
Application Experience
HIPAA transactions(X12) Sterling Connect Enterprise & B2B Sterling Integrator ITX/ITX-A Websphere Transformation Extender (WTX/Mercator) software Tibco Desktop Validator Azure Fundamentals AZ-900 ServiceNow SFTP / HTTPS HP Quality Center Sharepoint Facets/Trizetto software Microsoft Office Suite Adobe Acrobat Reader/Writer Sql BCBSA Business Associate Profile (BAP) User Acceptance Testing & regression
City
Coventry
Street
81 Arabian Drive
Affiliations
- I enjoy thrifting, knitting, outdoor activities, biking, skiing, spending time with my family and friends, as well as my pets.
Certification
- ITIL 4 Foundation (Introduction to leadership) August 4, 2023
- Azure Fundamentals AZ-900 January 26, 2021
Timeline
Software Dev Advisor
NTT DATA Services, Inc. | Healthcare Consulting Group
11.2016 - Current
Software Dev Advisor
Dell
03.2016 - 11.2016
Senior Support Analyst
Blue Cross Blue Shield of Rhode Island
01.1988 - 03.2016
Bachelor of Science - Marketing
University of Rhode Island
- ITIL 4 Foundation (Introduction to leadership) August 4, 2023
- Azure Fundamentals AZ-900 January 26, 2021
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