Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

Dianne Sprouse

Quinton,VA

Summary

Accomplished and successful long term tenure with ESIS, Inc. for 31 years in both Operations and Technical claims background. Excellent in training new hires and seasoned professional on update material and information for Claims handling, State requirements and Systems.


Proficient in all released of EDI requirements. Familiar with new ECOS systems as well as Medicare, NCCI/DCI reporting and all aspect of EDI functions within the ESIS organization.

Overview

18
18
years of professional experience

Work History

Senior Claim Analyst

ESIS, Inc.
Glenn Allen, VA
03.2015 - Current
  • Manage the daily feeds between ESIS and EDI States, identify feed issues and correct errors.
  • Manage daily reports to ensure 90% or better successful reporting to the State. Daily reports include Acknowledgement Report, Edit Report, Missing Acknowledgement Report, if applicable to the State, Rejected Not Resubmitted Reports, if applicable to the individual State.
  • Manage dairies on transaction to ensure timeliness of corrections and updates.
  • Review and follow up on Mitchell reports.
  • Identify trends for training for both the Operations and Technical staff.
  • Communicate changes as needed.
  • Training new hires on ESIS Best Practices for Operations and Technical personnel.
  • Manage additional Carrier or State reports as required within the State.
  • Effective communications with State entities, IBM, Internal employees with timely response.
  • Manage State forms as required per jurisdiction.
  • File EDI as directed by Forms or State request.

EDI Coordinator

ESIS, Inc.
Glenn Allen, VA
03.2007 - 03.2015
  • Handled EDI for Virginia, North Carolina, South Carolina, Tennessee and Kentucky.
  • EDI backup for Florida, Georgia, Pennsylvania, New York, Texas, California, Colorado and Utah.
  • Maintained a 90% or better rate for State filings.
  • Reviewed and corrected EDI reports for internal job queues.
  • Maintained Medicare reporting responsibilities for the Glen Allen and Maryland offices.
  • Completed and updated OMNI for NCCI/DCI reporting for the Wilmington, Atlanta, Maryland, Florida and Glenn Allen offices.
  • Payment Expert for OMNI payment codes.
  • Responsible for requesting Police Report, Death Certificates, Incident reports using Metropolitan Reporting Bureau.
  • Responsible for Third Party Administration mail.
  • Researched coverage issues.
  • Completed request for ISO reports.

Education

High School Diploma -

New Kent High School
New Kent, VA

Skills

Communications

Expertise in the EDI filed for Release 1,2 and 3

Excel

SharePoint

Access

Visio

Additional Information

As an employee with ESIS, Inc. now for 31 years, I have held many positions that include, Switchboard Operator, File Clerk, Transcriptionist, Claims Assistant, Administrative Assistance, Adjuster as well as EDI Coordinator and Senior Claims Analyst. I also have working knowledge of RSI and SIU procedures.


I have been part of testing several systems upgrades from EFT, Disability Cycles as well as working knowledge of the new ECOS System.


I believe that with my knowledge and experience, I would be an exceptional candidate for this position.

Timeline

Senior Claim Analyst

ESIS, Inc.
03.2015 - Current

EDI Coordinator

ESIS, Inc.
03.2007 - 03.2015

High School Diploma -

New Kent High School

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Dianne Sprouse