EDI Business Analyst with 18 years of experience as an IT professional in the Health Care field specializing in Medicaid and Government environments.

1. Jacquelyn M.Pryor
1609 Saddlehorse Place
Henrico, Virginia 23231
Cell: (804) 543-9266
msjmp804@gmail.com
www.linkedin.com/in/jackiepryor/
QUALIFICATIONS SUMMARY:
EDI Business Analyst with 18 years of experience as an IT professional in the Health Care field specializing in
Medicaid and Government environments.
PROFESSIONAL EXPERIENCE:
CSRA (formerly Computer Sciences Corporation), Senior EDI Business Analyst, January 2011 –
present.
 Extensive experience in gathering requirements, performing gap analysis, creating design specifications,
developing test plans and creating system documentation in the development of Healthcare applications
 Participated in various initiatives like HIPAA, NPI, 5010, ICD-10, MITA, CORE/ CAQH, Real time claims
adjudication, DDE
 Performed summary and detailed gap analysis between 4010 and 5010 versions of 837, 270/271, 835, 276/277,
278, 834 and 820 involving client specific impacts and design considerations
 Development and transition exposure to Medicaid Management Information Systems (MMIS) with thorough
understanding of its subsystems like EDI, Claims, Provider, Recipient and Financial Sub Systems
 Certified and trained on HIPAA Privacy and Security measures
 Provide post production Contingency plans for MMIS and HIPAA operations
 Involved in research and gap analysis of 5010 and ICD-10 with their older counterparts
 Knowledge of Medicaid Information Technology Architecture (MITA) and CAQH/ CORE frameworks
 Expertise in review and documentation of system test plans, creating test cases on the basis of products releases
features, client’s requirements and related technical documents
 Very strong at messaging and EDI application development, implementation, administration and support using
Pervasive Data Integrator, EC-Map, EC-Gateway, and See Beyond
 Responsible for modifying existing companion guides to conform to the new WEDI 5010 standard Companion
guides
 Worked with Peers to create and deliver detailed gap analysis documents and logical maps for the new 5010
transactions.
 Involved in design, development, testing, implementation and support of various EDI modules of Medicaid
Management Information Systems (MMIS) and Pharmacy subsystems.
 Responsible for 820, 834, U271, 276/277, U277, 270/ 271 Batch and Real-Time Transactions for various state
Medicaid, Pharmacy and ePrescribing accounts
 Researched and developed system specifications for new Eligibility, Claim status and Prior Auth Modules
 Involved in automating standard maps and scripts provided by Sybase Suite (Ec-map EC-Gateway)
 Involved in the transition to NPI compliant MMIS system
 Monitored and ensured that client requirements translate into viable Healthcare solutions with significant cost
saving and optimization
 Responsible for documenting various EDI related business processes as per clients requirements
 Performed summary and detail Gap-Analysis between 4010 and 5010 versions of the 270/271, 835, 276/277, 834,
820. This involved client specific Impacts and design considerations.
 Conducted Impact Analysis for 5010 and assisted the States to get Federal funding for the enhancement.
Magellan Medicaid Administration (formerly First Health Services), EDIAnalyst, December 2002 –
January 2011.
 Served as a liaison among the HIPAA team, VA-DMAS, NV-DHHS and the MMIS counterparts
 Work with EDI support and clients to understand and resolves issues.
 Performed summary and detailed gap analysis between 4010 and 5010 versions of 837, 270/271, 835, 276/277,
278, 834 and 820 involving client specific impacts and design considerations. Performed gap analysis for 5.1/D.0
for NCPDP implementations for pharmacy clients.
 Supported numerous ePrescribing implementations for 270/271 and Medication History transactions.

2.  Expertise in review and documentation of system test plans, creating test cases on the basis of products releases
features, client’s requirements and related technical documents
 Participated in numerous successful software upgrade initiatives requiring extensive planning and testing in order
to mitigate risk.
 Participated in X12 and WEDI workgroups and conferences. Provide summary reports of industry changes.
Commonwealth of Virginia, Programmer/Analyst; April 2000 – October 2002.
 Performed maintenance on existing programs for the Electronic Data Interchange (EDI) system, Fixed Assets
Accounting Control System (FAACS), and Commonwealth Accounting Reporting System (CARS) in a batch
COBOL environment.
Electronic Data Systems, Information Programmer; February 1998 – December 1999.
 Applied acquired skills to design and implement programming projects for First Union National Bank, with the use
of COBOL II in an MVS environment, VSAM, DB2, SQL, JCL and Easytrieve in a batch environment.
EDUCATION AND TRAINING:
Strayer University, Master of Health Services Administration, October 2012
Strayer University, Bachelor of Science in Computer Information Systems, June 2004
J. Sargeant Reynolds Community College, Information Systems, December 2000
U3 UNIX Training Inc, Certification, UNIX Systems Administration, February 2000