SUMMARY:

Business Management graduate with extensive healthcare benefit specialist and administration, account experience including vendor management, national product and program oversight; years of project management, project implementation lead, and operations/supervision, is seeking a role in business development, consulting, management, or business/gap analysis.

SKILL:

Microsoft Office Suite - Microsoft Outlook, Excel, PowerPoint, Access, SQL, Visio, SharePoint. SAP, PeopleSoft, Medical Coding and Billing, Prior Authorization, Open Enrollment, HIPPACMS, ERISA. COBRA, OBRA (QMSCO, ESRD), Coordination of Benefits, Managed Care.

EMPLOYMENT HISTORY:

Confidential

Percepta Litigation Administrative Assistant

Responsibilities:

• Responsible for supporting the clerical needs of the Litigation Analysts and Legal Team.
• Interface with national legal team to ensure electronic file is available, and maintained.
• Monitor and process checks/requests, update records, and retrieve information as needed.

Confidential

Bartech Analyst

Responsibilities:

• Analyze unbilled Accounts (Commercial) to determine appropriate course of action required to resolve billing related matters, review and resolve outstanding invoice reports.
• Interface with Suppliers and Account Managers to parallel overall business strategies adhering to special program guidelines and compliance to legislation.

Confidential

Functional/Benefits Analyst

Responsibilities:

• Project manager responsible for establishing deliverables/milestones, facilitate weekly meetings with stakeholders to resolve eligibility/d Confidential warehouse issues, implement product changes, enhance pension and retiree medical eligibility files.
• Oversee daily processing of inquiries and reporting, act as focal point of contact for junior staff in resolving inquiries, and plan interpretation.
• Create test plans and assist system delivery staff, validating test results, updating tickets, btain account approval of findings, coordinate updates with client and third parties.
• Identify actions requiring remedy tickets and completes and submits remedy tickets through the client’s HRIS system.

Confidential

Sr. Account Rep.

Responsibilities:

• Design, implement, and administer multiple healthcare benefit plans, products and programs.
• Interface with clients (autos), vendors, and other carriers, providing project and analytical support to ensure consistent administration, system delivery, and customer service.
• Project lead/team member on requirements definition and testing activities, providing coordination of cross functional activities and follow - up/resolution on complex problems.
• Project lead on multiple product and program changes which required claims processing system knowledge and benefit plan knowledge to confirm/test/approve to valid whether changes met requirements.
• Address contract language concerns/updates, maintain and optimize benefit documents including administrative health care manuals, summary plan descriptions and other materials as required to meet current and future regulatory compliance requirements.
• Support finance staff and audits on subrogation, recovery, worker compensation, and secondary liability matters.
• Support open enrollment at plant sites, providing expertise on benefit changes and products; follow-up and respond to enrollees, update benefits at a glance, coordinate non-Blue carriers.
• Identify, resolve potential customer service concerns, claims logic processing variances or gaps (NASCO, Blue Card), and create/coordinate action/test plans.
• Draft communications (providers. benefit reps, and members), update national customer service benefit documentation, provide as needed.
• Respond to benefit/contract questions from UAW benefit reps, establish and maintain provider or product networks, resolve claims/eligibility matters.
• Assists customers on migrations to new or revised products, applications and platforms.
• Oversee file updates including manual feeds to ensure timely/correct files and generation of ID cards.
• Finalize service level agreements and addendum (monitor performance), Involved in all aspects of proposal development related to vendor management and subcontractors, including requirements related to diverse suppliers; update SPD language, ensure documentation remains current.
• Website technical support (create HTML pages, testing, approval, maintenance, etc.) and project lead assisting programmers to develop and implement a healthcare portal (HCBO)providing internet access by to expanded benefit information and self-service features such as the ability to order ID cards and make changes.
• SME/Primary contact on all Medicare related issues, resolve primary/secondary liability matters, interface with vendors to ensure compliance with CMS and HCFA regulations
• Train, direct, and plan the activities for 28 staff (rep and non-rep), meet quality and performance standards (phone and written inquiries); provide merit reviews, budget, etc.
• Support assigned physicians providing guidance on program and managed care products.
• Document procedures, train and develop materials on program and guidelines.