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Development
- Developed
InfiniMed’s IMEDI Inegrator. EDI interface engine and web
oportal that allow fast flexible setups and implementations. Supports
flat files, HL7, X.12 and XML
- Developed
and continue to develop InfiniMed’s Package of IDX Flowcast
Programming tools. Menuing, Data extractors, HTML tools, standardized
system utilities
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EDI and Interfacing
- Data Junction
X.12 mapping, specifications, and executables. A cost effective
solutions to mapping existing data to the X.12 standards for transmision
to trading partners
- 835: (Remittance)
Install and setup trading partners, specs, mapping, exceptions
and reporting.
- 834: (enrollment
roster) Install and setup trading partners, specs, mapping, exceptions
and reporting.
- 278: (referrals
Provider/Response, Payor/Request) Install and setup trading partners,
specs, mapping, exceptions and reporting.
- 837: (claims)
Upgrade trading partner portals, specs, mapping 837 from 3051
to 4010 format
- 276/277:
(Claim Status) Setup 276/277 and associated 997 and TA1s within
MCA.
- 837/835:
Migration of MCA 837& 835 from 3051 format to 4010 format.
- 837/835:
Setup 837/835 4010 - BAR
- 837/835:
Setup 837 & 835 - HPA
- 837/835:
Setup 837 & 835 - MCA
- Technical
resource to internal IDX staff for the IDX EDI X12 functionality
- Interface
pre-processor to reformat files from external vendors into the
IDX standard formats
- Enrollment
preprocessor for interfaces from outside vendors to IDX Standard
MCA Batch Enrollment specifications
- Setup IDX
270/271 real-time transaction. SEtup IDX 270/271 batch transaction
using the hold file functionality fo the real time transaction
- Setup MCA
incoming 271 specifications and drivers using IDX’s EDI
Beta 271I software
- Developed
outgoing X12 and HL7 drivers producing structured records for
physician directories, benefit plans, referrals, claims, and 835-remittance
advice
- Setup MCA
outgoing X12 271O eligibility interface using IDX EDI software
- Setup for
MCA claims using the IDX EDI software and the X12 837I and X12
835 EDI spec
- Developed
outgoing flat file interface driver for membership, FFS patients,
claims, BAR transactions, referrals and dictionaries
- Interface
between IDX and the PC based application 3M Coding and Reimbursement
System using the DataMax option
- Interfaces
to IDX MCA ID Cards from within MCA and the Customer Service Module
- Development
of InfiniMed IMEDI Data Extractor: Software Tools which allow
AES programmers to quickly create outgoing interface files (837,
271, 835, BPD, Referrals, dictionaries, etc. (formats flat file,
HL7, X12, XML)
- Developed
outgoing drivers (InfiniMed's IMEDI Data Extractor) to create
outgoing X12 extracts
- Modified,
and enhanced numerous data extracting tools to extract data from
IDX including claims and enrollment
- MCA data
warehouse conversions, interfaces, and documentation
- IDX to Oracle
AP interface
- Outgoing
HL7 conversions
- Outgoing
General Ledger interfaces for several IDX clients
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GE/IDX Reporting
- Modified
Standard IDX reports by copying reports to AES and customized
them to meet our clients needs
- Custom reports
and extracts within and between the MCA, BAR and SCHED product
- Developed
additional reporting in Customer service module
- Numerous
reports from BAR, MCA, SCHED and all other applications offered
by IDX
- Medicare
risk reconciliation report
- Custom charge
lag report
- Duplicate
patient reporting tools
- Custom month
end reports
- Third visit
scheduling report
- Created,
modified, and enhanced numerous data extracting code including
but not limited to: smart system variables for use in plan exception
logic, vendor contract exception logic and DBMS custom columns
for use in rule banks
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Custom GE/IDX
Screens/Pages and Functionality
- IDX Enrollment
and Claims screens to allow tracking and verification of pre-existing
conditions
- IDX Referral
module to allow entry of QI indicators for NCQA tracking
- IDX Enrollment
and Claims screens to comply with Federal HIPAA regulations
- IDX Case
Management Module to allow tracking of Health Promotion Health
Alerts
- IDX Provider
Module by adding screens and fields and changing existing screens
- EOBs and
ID Cards
- Created
Medicare participation history screens within the provider module,
utilizing the IDX DBMS software
- IDX Customer
Service module with custom action codes, screens, fields, and
reports
- IDX Customer
Service Module: setup and custom enhancements to screens and reporting
- Large Scale
customization to Customer Service Module. Created separate reporting
modules, which afforded users to query on many existing and new
fields
- Medicaid
re-billing subsystem
- Referring
physician repository to track monthly, quarterly, and yearly statistics
- Developed
stand-alone application to help with payroll, collection of data,
and processing of paychecks
- Created,
modified, and enhanced numerous IDX data retrieval tools including
but not limited to: system variables, report variables, selection
conditions, sort variables, facesheet variables, claims logic
and claims variables
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Reflections
and SmarTerm Scripting
- Developed
various scripts for the automated entry of fee schedules, dictionary
population, and interface start-up procedures
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Tech Support
- Performed
role of project manager for an MCA upgrade project. Came on time
and within budget
- Customer
Service Module: Installed and setup the IDX customer service module
- Technical
Resource for IDX Managed Care clients upgrading to MCA 8.0+
- Technical
Resource to internal IDX staff for the IDX EDI X.12 functionality
- Claim Form
Generator: Developed and modified Electronic Medicare, Medicaid,
& Medi-Cal claim forms
- VMS level
support for regional HMO. Analyzed and controlled volume space
on Alpha and VAX platforms. Managed AES security by adding, modifying,
and deleting users
- VMS level
support for a large hospital. Analyzed and maintained VAX disk
space, moved and renamed directories and disks as needed. Managed
VMS level security by adding, modifying, and deleting users. Ran
integrity checks and supported backup procedures
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