Y

Yuri Grishko

About

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Agoura Hills, California, United States

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Résumé

Jobs verified_user 0% verified
  • A
    IT Manager, EDI Business Operations
    AMM - Advanced Medical Management, Inc.
    Nov 2022 - Feb 2023 (4 months)
    Led operations team of the electronic documents processing department. • Managed EDI encounters data reconciliation processes for all AMM clients, health plans and CMS. • Performed development and operations management of the inbound data feeds including all claim file types, Reconciliation files, eligibility and capitation data – SQL, SSRS, EDIFECS, Excel. • Managed outbound encounter data submissions using EDI, Alternate Submission Methods (ASM), and supplemental Clinical data submissions to HP trading partners or designated clearinghouses. • Enhanced operations to comply with government regulations and business partners requirements. • Led EDI related projects (PMI, ERP). Managed compliance with requirement policies and procedures.
  • I
    Independent Project Manager
    May 2020 - Oct 2022 (2 years 6 months)
    During the job market decline helped friends and family with incremental business and tech projects. • Personal laptops, desktops, and home Wi-Fi/cable networks set up and support. • Home and private business computers software management and updates. • Provided help and support of the data collection, storage, management (SQL, Excel, etc.).
  • E
    IT Manager
    EDI Business Operations
    Feb 2019 - Feb 2020 (1 year 1 month)
    Managed IT department's EDI (Electronic Data Interchange) division for complete, timely, and accurate processing of inbound and outbound healthcare EDI transactions according to the industry standards, requirements of regulating agencies (CMS, DHCS, NCQA, etc.) and healthcare providers. • Ensured that data exchange processes always met requirements. Lead detail-focused and accurate communications among affected teams: business users, healthcare providers, and IT development. • Managed creation of new data reporting processes for Medi-Cal IPA Performance Evaluation Tool (PET) through detailed business requirements analysis, data validation, IT development, and QA. • Coordinated technical design, planning, development, and QA steps of EDIF
  • U
    IT Manager / Sr. Technical Project Manager
    United Healthcare March Vision Care
    Jul 2014 - Sep 2018 (4 years 3 months)
    Managed strategic planning, development and implementation of IT initiatives related to healthcare data processes and secure electronic data exchange with business partners. Provided IT staff mentoring, performance management and improvement recommendations. • Supervised design, development, production support, and upgrades of EDI medical claims processes for more than 7 million healthcare patients and full compliance with mandatory PHI data management regulations (HIPAA, HITECH, SOX, SSIS). • Planned and successfully managed mandatory ICD10 upgrade of 200+ Healthcare EDI processes. • Performed technical evaluation of IT system upgrades, leading technical design and end-to-end development of IT projects including risk mitigation, motivat
  • Kaiser Permanente
    IT Manager, EDI Business Operations
    Kaiser Permanente
    Nov 2012 - Nov 2013 (1 year 1 month)
    Managed EDI Business Operations group through mentoring, performance management, and staffing decisions; led business operations via business analysis, IT production support, change management, project planning, coordination, and systems maintenance. The directly managed Claim Processes group performed extremely efficiently and delivered outputs according to SLA. • Managed strategic development and implementation of HIPAA mandatory EDI system upgrades. • Improved project requirements documentation (BRD, FRD, TRD) process. Issues dropped by 50%. • Participated in planning of cross-department regulatory compliance development (HIPAA, SOX). • Attended national EDI industry conferences (ASC X12, WEDI) and participated in the knowledge shari
  • D
    IT Technical Lead
    DaVita, Inc.
    May 2010 - Oct 2012 (2 years 6 months)
    Provided leadership of IT development team and technical management of the EDI Operations group.
  • Molina Healthcare
    IT Technical Lead
    Molina Healthcare
    Feb 2006 - Jan 2010 (4 years)
    Managed design, development and production support of EDI and SQL projects critical for timely and accurate submission of Medicaid/Medicare claims to the government agencies.
  • Inland Empire Health Plan
    IEHP
    Inland Empire Health Plan
Education verified_user 0% verified
  • K
    MBA
    Keller Graduate School of Management, Devry University
    Jan 2010 - Dec 2013 (4 years)
    Business Administration and Management
  • A
    M.S.
    Aviation Engineering Academy
    Jan 1995 - Dec 1999 (5 years)
    Electrical Engineering and Computer Science
  • M
    M.S.
  • M
    MBA