SUMMARY

• Developed and recommended operational processes and process improvements and in support of Facets clients.
• Configured, tested and documented Facets configuration solutions.
• Examined Facets system configuration for functional optimization and developed, tested new functionalities and upgrades.
• Strong experience with Facets Workflow Configurations for PCA, Claims and Customer Service.
• Business Object skills to develop queries using the universes
• Proficient with Facets Group and Subscriber Configurations.
• Thorough knowledge of lines of businesses including (EPO, HMO, POS, PPO, Medicaid and Medicare).
• Provider Build. Network Build. Provider Contract configurations
• Defined and analyze business goals, objectives, needs, processes and requirements for production - related system changes.
• Professional Development: Member of PMI Institute.

TECHNICAL SKILLS

• Facets
• Facets Workflow Applications
• Xcelys (formerly Diamond)
• MS OfficeSiebel
• Lotus Notes
• Clarity
• Crystal Reports
• Cisco IOS
• ATU Tool
• SQL Queries to Troubleshooting
• Process Mapping
• UAT
• Access Database
• PIMS
• POWER MHS

PROFESSIONAL EXPERIENCE

Confidential, Atlanta, Georgia

Instructor IT Services and User Experience

Responsibilities:

• Provided Various levels of IT Training on Health Care Domains
• Facilitated and mentored students on building various health products, Claims processing and Provider reimbursement and Provider Records setup in Facets.
• Instructed students on various office suits software.

Confidential, Durham, NC

Lead Senior Business Application Expert/Facets Configuration Analyst

Responsibilities:

• Provider Data Oversight and Validation from downstream processes and departments.
• Ensures accuracy of data, interpret results and make recommendations.
• Manages multiple projects, developing and training of claims related issues on error resolutions while utilizing standard SQL reporting tools.
• Perform weekly analysis of provider data, payment related issues and general configuration issues.
• Collaborated with PDM, Finance and other operational areas to develop reports for monitoring of triggered events, such as contract changes, provider patterns.
• Provided Summary level reports to identify trends and anomalies during data validation and performances. Develop process to mitigate against failing points.
• Manage issues tracking utilizing access database to resolve issues within timeframes and escalates open issues as needed when SLA is exceeded.

Senior System Support

Confidential

Responsibilities:

• Analyze Provider configuration in Power MHS and provided mapping instructions for conversion to Facets environment
• Build IPA, Provider Groups ad Practitioners in Facets
• Final point of escalation with provider related issues
• Build provider contracts with their contract rows in Facets
• Responsible for designing and configuration of Pediatric Dental
• Deep knowledge of Provider space in Facets
• Performed and coordinated defects resolutions across functional design areas
• Efficient management and completion of multiple projects by or before the assigned date
• Interpretation of contract language
• Test and quality check of configuration build using claims parameters
• Create new and update existing fee schedules and NetworX Qualifier Groups
• Trouble shoot provider Agreement for NetworX Pricer, Global Agreements
• Calculation Categories, Add Qualifier Groups by Age, Procedure and Revenue Codes
• Gathering and analyzing product and project requirements to determine configuration impact
• Perform unit and user acceptance testing as part of configuration validation
• Develop my queries using Business Object to validate or mine data from Facets reporting server.
• Last point of escalation for all Provider Claims related issues resolutions
• Provided defect resolution and support to the business teams and technical teams during system testing and user acceptance testing
• Identify and implemented processes to improve configuration activities
• Participated in several JAD sessions for PIMS to Facets project
• Participated and contributed to JAD sessions for PIMS to Power MHS projects
• Created Technical documentations for all phases of provider implementations of Provider build and configuration training guides for network management group.
• Provided Training using my developed DTP for new Associate business Analyst with zero knowledge of Facets.
• Mentored new hires to functional roles. Developed step by step guide to problem resolutions

Confidential, Baton Rouge, L

Facets Configuration Analyst/Business Engineer Analyst

Responsibilities:

• Built Product renewal for small and large business groups.
• Removal of Annual and Lifetime Limitations All cost Shares to apply to OOP.
• Configure Separate In & Out of Network Deductibles.
• Configure and work inside Subscriber/Member Applications to build Group Administration from Client Manager, and built them in Facets v.5.01. Administered renewal, new groups and sub groups. Grand Fathered and Non Grand Fathered. Built Customs fully insured group and renewals.
• HCR configurations include but not limited to Mental Health, Prescription, LABs, Applied Behavior Analysis for IP and OP, Medical Procedures, Hepatitis C Screening Office, Hearing Aides, Oral Surgery, Low Protein Food Mandates, Wellness, Colonoscopy, MAMO etc… in the new supplemental tables and old supplemental tables.
• Performed production support, working on Service Desk Tickets. Various tasks and configuration was performed, such as SEPY modifications via rules changes, built new rules, SPCT configurations, etc.
• Working on Service Desks Tickets for defects.
• Build and Configure Supplemental Procedure, Revenue Code and Conversion Rules using Facets v.5.01 BPA Tables.
• Configure SPCT/SRCT, SPCR/SRCR, AGSE, DEDE, LTLT, SEDF, UTSE, Utilization Management, Authorization Management and Components of product build.
• Complete Facets v. 5.01 Group Build for Small Businesses, including Class/Plan Build.
• Support client configuration changes and new configuration requirements, including configuration analysis, design, build and test.
• Use Access to query Facets tables to extract data.
• Create PCA’s from Change control Requests. Conversion Service ID’s to Procedure or Revenue Code mappings.
• Create and modify the following but not limited to Service ID’s Descriptions, Limit Rules, SERLS, SEPY’s, Accumulators.

Confidential, Grand Rapids, MI

Project Manager/Product Owner/Senior, Business Analyst

Responsibilities:

• Configured and worked inside Subscriber/Member Applications to build Group Administration from Client Manager, and built them in Facets v.5.01. Administered renewal, new groups and sub groups.
• Built and Configured Supplemental Qualifier Groups in Facets v5.01 Business Process Automation (BPA) Tables.
• Built and Configured Supplemental Procedure, Revenue Code and Conversion Rules using Facets v.5.01 BPA Tables.
• Completed Facets v. 5.01 Group Build for Small Businesses, including Class/Plan Build.
• Write DLP for work Processes, wrote detail documentations on understanding the product build process.
• Completed Data Store processes, using Access to query Facets tables.
• Created User Stories, Managed the Dashboard, Coordinated daily scrum meetings on Agile Management of the ICD 10 Project as a Product Owner.
• Developed training modules on SPCT, SRCT mappings to Service ID’s.
• Created PCA’s from Change control Requests. Conversion Service ID’s to Procedure or Revenue Code mappings.
• Created and modified the following but not limited to Service ID’s Descriptions, Limit Rules, SERLS, SEPY’s, Accumulators.
• Wrote SQL statements to extract data from data store. Access Database ODS.
• Product Owner for ICD10 Project migration from ICD9 utilizing Agile Project Management methodologies.
• Participated in the implementation of Dental Migration to TUO 6.