TECHNICAL SKILLS:

Experience includes: Pega Platform, OMNI (Pega Application), UMV (Unified Member View), Amisys Claims System, qTest, Portico (Physician, Hospital Configuration System), Windows, Lotus Notes, Photoshop, Dreamweaver, Outlook, Microsoft Office 365, Excel, PowerPoint, FTP, Sharepoint, BiQuery Teradata, Adobe Connect, Siebel, SQL, Ad - Manager Pro, RX-Claims, IBM Anchor, Amisys, Service Now, CRM, BMC Remedy, EpicCare Link, Epic Hyperspace, Confidential Clinical Browser, Kronos Human Resources System & Avantas SmartSquare Staffing database.

PROFESSIONAL EXPERIENCE:

Confidential, St. Louis, MO

Business Analyst III

Responsibilities:

• Business ProjectLead for OMNI System Implementation for Medicare, Affordable Care Act & Medicaid lines of business. Business Project Lead & Centene Liaison for HealthNet HealthCare company transition of OMNI Pega Application.
• Responsibilities include Agile Product Owner, writing business requirements & technical design requirements.
• Skills include data requirements for system integration of databases Mongo, EDW (Electronic Data Warehouse) & RTR (Real Time Repository).
• Partnerships with other Centene departments include Claims, Web, Provider Data Management, Medical Management, Contracting & New Business Implementation.
• Responsibilities include working with Network Contract & Development for contract configuration. This includes interpretation for payment arrangements according to Medicare guidelines.
• Duties include working with Provider Data Management to ensure correct & valid Taxonomy and NPI configuration for provider setup.

Confidential, St. Louis, MO

Client Benefit Analyst

Responsibilities:

• Contractor through Kforce Staffing for Benefit Design Implementation of Anthem Wellpoint Pharmacy Benefit Plans within Confidential Client Services Department.
• Daily tasks include processing service requests from Houston, a Siebel based platform for all benefit design work requests. Responsible for working with Intake Mangers for client intent and clinical benefit setup.
• Service Requests include new benefit creation, changes to client rebates, prescription copay amounts, dispensing, drug coverage and indemnities.
• Specializing in mail order modifications, SQL/Teradata based queries, project management, utilizing data dictionary for database updates, batch benefit implementation, Medicaid drug group builds & Q/C testing.
• Principle Trainer and Team Leader for Confidential 1st ever implementation of Manila, Philippines Offshore Analysts. conducted using Adobe Connect and Microsoft Office Live Meeting.
• Benefit creation accuracy for Wellpoint Pharmacy benefits exceeding over 95% in the top 10% of the ESI Client Benefit Analyst Team.

Confidential, St. Louis, MO

Pharmacy Benefits Representative & Pharmacy Help Desk

Responsibilities:

• Tasks include a multi-line call center environment working with customers internally thru the LDI Pharmacy and various national plan administrators.
• Workflow includes ordering new member cards, assisting pharmacies with electronic processing of claims, following plan guidelines for requesting prior authorizations & following HIPAA guidelines for EOB requests.
• Specializing in trouble shooting claim payments, prescription copays, coordination of benefits, deductibles & eligibility. Also responsible for real time updating member eligibility & working with third party medical vendors regarding indemnity file transfers.

Confidential, St. Louis, MO

Physician Connectivity Coordinator & Epic Product Specialist

Responsibilities:

• Daily tasks include legacy clinical systems and other information system applications such as BMC Remedy Ticket System, SSM Physician Portal, SSM Connect, and Confidential Clinical Browser for physician connectivity.
• Workflow includes provisioning access to (EHR) Electronic Health Record System - Epic Hyperspace and EpicCare Link to SSM Physicians, medical staff, office support staff and staff with such companies as Saint Louis University and Barnes Jewish Hospital to access Confidential t records. Also responsible for meeting SLA requirements within SSMHC IT Department & reviewing Sharepoint for Physician materials.
• Specialty includes setting up electronic web portal pages for Residents, Fellows and Medical Students performing rotations at Confidential St. Louis.

Confidential

Staffing Resource Specialist

Responsibilities:

• Duties include maintaining proper Confidential t census numbers, strictly adhering to budgetary staffing guidelines, keeping units above critical levels & working with hospital Nurse House Supervisors to schedule units.
• Data entry using SmartSquare Staffing Database for employee absences, incentive pay, schedule changes, shift trades and referrals of SSM Employment Policies and Procedures.
• Experienced with working 12 to 16 hour overnight shift staffing 7 days a week for Confidential St. Louis.
• Additional duties include on HIPAA Guidelines precise mathematical & communication skills, attention to future staffing needs, relationship building with medical professionals & maintaining high professional standards.

Confidential, St. Louis, MO

Advertising Account Executive

Responsibilities:

• Responsible for image consulting and brand recognition within the legal and financial communities.
• Daily tasks include networking & prospecting for new retail advertising accounts within the St. Louis business community.
• Extensive experience with deadlines, communication techniques & project management.
• Advertising Sales Account Management Specialist for such law firms as Sandberg, Phoenix & von Gontard, Armstrong Teasdale and Evans & Dixon.