Jeffery Rayson

• The EDI Analyst will be a part of a team supporting all phases of the design, development and implementation of an Enrollment Resolution and Reconciliation process for health insurance exchanges.
• The Analyst will participate in design sessions, report on project progress and identify potential risks and issues.
• The EDI Analyst will be responsible for troubleshooting and resolving transaction errors for health insurance exchanges and performing root cause analysis.
• The EDI Analyst will also be responsible for analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continuous process improvement of the reconciliation process.
• The analyst will provide content to and for collaboration with training staff on training stakeholders on the transactions and the reconciliation process.
• The Analyst may be required to provide training on the transactions and on the reconciliation processes.
• Responsibilities: Identifying and solving customer information and processing problems.
• Applying triage, research, collaboration, and technical knowledge to resolve transaction and processing issues.
• Analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and create 1095-A.
• Participation in all phases of testing Perform testing and thoroughly document issues.
• Work with the technical and development team to resolve identified issues in a timely manner.
• Review documented training material for accuracy and assist in end user training and support.

• · Responsible for maintenance upgrades and patches on 5 HP3000's and 2 HP9000
• · Provided support for 2000+ user base located worldwide.

· Utilized Quest's Netbase to provide data shadowing and print- sharing across multiple systems.

• · Mounted and remounted private volume sets.

Scheduled backups and database maintenance jobs via JMS and Maestro.

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• This project was the redesign of claims processes in AMISYS system.
• Configuration of existing system with Facets for Group, eligibility & claims Compliance check of various transactions according to HIPAA rules (834, 278) and X12 standards Re-engineering and capturing of transactions with legacy systems [Enrollment -834, Health Plan Premium-820, Eligibility Transaction (270/271), Referral/Authorization (278), Claims (837) Claim Status Request and Response (276/277), Remittance (835)] Responsibilities: Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance),270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan) Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Experience on Error handling and Functional libraries using Quick Test Pro.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions Worked on following applications Business Objects, Enterprise Architect, Microsoft Suite (Word, Excel, PowerPoint, Visio).