SKILLS

• Needs assessments SQL Dashboards Business analysis Project Management Risk management
• processes analysis Charge Description Master Electronic Data Interchange Tableau Communication
• Process Improvement Predictive modeling Facets Configuration Data collection and analysis Data mapping
• Web - based reporting tools Excel, Pivot Tables Statistics Epidemiology Public Health Safety Quality assurance
• Relational databases Documentation management HEDIS Quality Management
• SQL Server Reporting Services (SSRS) SDLC Research Records review Team building

PROFESSIONAL EXPERIENCE

Sr. Facets Configuration Analyst

Confidential, Phoenix, AZ

Responsibilities:

• Facets Configuration Analyst - including configuration experience with Facets, NetworX integrated pricer, Rapid SQL Working claim defects, Backend updates on Facets prefixes Facers Workflow application, Unit testing Building Fee Schedules and Rate Sheet Updates.
• Design solutions based on Facets capability Benefit Configuration, specifically with Supplemental tables (BPA: SPCR/SRCR, SPCT/SRCT) and Service Definitions (SEDF) Document benefits and medical definitions in Facets.
• Review provider contracts and compare data to validate provider/pricing. User Acceptance Testing.

Data Analyst/Clinical Data Managers

Confidential, Houston, TX

Responsibilities:

• Data analysis and coding Investigated and addressed HL7 and system interface issues to enhance usability and improve functionality across disparate systems
• Prevented duplication or data corruption Produced monthly Charge Description Master updates for integrated delivery network
• Produced Unknown Charge Code reports and interface error reports
• Orchestrated smooth and effective flow of interface data to support Coders users in coding and billing process
• Investigated and addressed interface error system issues to enhance usability and improve functionality
• Updated organizational and joint venture crosswalk correlation subsystems to improve and streamline data collection Recommended data standardization and usage to ensure data integrity
• Participated in requirements meetings and data mapping sessions
• Identified and documented detailed clinical guidelines and use cases based on requirements analysis
• Offered data-driven recommendations aligned with overall company strategies and prioritized process improvement initiatives
• Collaborated with team to define business requirements for organizational processes, achieve productivity standards and adhere to accuracy standards
• Built and maintained charge code databases for Joint Venture Partners
• Applied pricing and mark-ups to charge codes aligned with each Joint Venture Partner
• Maintained Joint drug formularies for each Joint Venture
• Updated database for CMS ICD-10, CPT, HCPCS annual updates
• Configuration of Product Tables (Service ID’S, Benefit Summaries, Service Payment, Service Rule, Limits, and Billing Components,)
• Preformed Claims Testing Benefit package configuration setup and maintenance
• Performed monthly internal Auditing on workflow processes
• Identified and resolved process issues to encourage smoother procedures, more efficient workflow and overall business growth
• Offered data-driven recommendations aligned with overall company strategies
• Prioritized process improvement initiatives Evaluated quality problems and initiated protocol toidentify and resolve issues
• Partnered with cross-functional teams to conduct thorough discovery and due diligence on existing processes
• Built and deployed plans, reports, validation procedures and entry processes for data management needs
• Worked with partners to coordinate Study Data Tabulation Model maps
• Assisted with database upgrades and migrations by performing user acceptance testing
• Developed team communications and information for project update meetings
• Managed quality assurance program, including on-site evaluations, internal audits and customer surveys

Project Manageer/Co-lead/Sponsorship Coordinator

Confidential, Atlanta, GA

Responsibilities:

• Raised 3 teams to LMP level 5. And maintain 4 teams at level 5 for 2 years until end of contract
• Reviewed performance benchmarks and established metrics for future tracking
• Presented business leaders with cost-benefit and return-on-investment estimations to drive project planning and execution
• Utilized effective mapping skills to holistically examine business processes and identify improvement opportunities Collaborated closely with upper management to drive strategy through development and implementation of new processes
• Applied knowledge of data modeling and statistical analysis to note trends and draw conclusions
• Monitored tasks of employees to assess information processing and performance to gauge business functions and inefficiencies
• Investigated and addressed system issues to enhance usability and improve functionality
• Assessed business needs and problem areas to create focused solutions like increasing JD Power score
• Developed flowcharts and diagrams to describe and lay out logical operational steps
• Gathered and defined customer requirements to develop well-organized project plans based on clear specifications
• Created dashboards for presentation to upper management for decision-making
• Identified new targets, developed new business opportunities, and presented product lines to customers
• Sought customer feedback and recommend operational changes to meet emerging trends
• Performed monthly ROI reports
• Maintained optimal financial controls by following loss prevention procedures

Health Information Technicians

Confidential, Marietta, GA

Responsibilities:

• Created and improved intelligence resources to facilitate consistent project outcome Processed daily Rx script data
• Evaluated consistency and importance of different BI data against needs to determine optimal courses of action Built library of models and reusable knowledge-based assets to produce consistent and streamlined business intelligence results
• Identified and documented project constraints, assumptions, business impacts, risks and scope exclusions
• Designed and developed schema data models
• Improved data collection through implementation of organizational subsystems
• Coordinated statistical data analysis, design, and information flow
• Participated in requirements meetings and data mapping sessions to understand business needs
• Transformed project data requirements into project data models
• Reviewed files, records and other documents to obtain business information and key data in order to respond to development requests
• Created workflow diagrams and Gantt charts to clearly demonstrate project processes and timeline
• Resolved pharmaceutical problems, improved operations, and provided exceptional client support
• Managed quality assurance program, including on-site evaluations, internal audits and customer surveys

Systems Analyst/Health Information Technician

Confidential Atlanta, GA

Responsibilities:

• Created and improved intelligence resources to facilitate consistent project outcome
• Assisted with configuration requirements during Facets implementations or upgrades.
• Complete analysis of Facets for benefits and medical definition
• Advised clients of configuration solutions and completed configuration and/or testing.
• Assisted clients with creation of “canned” queries for staff to use to pull data from Facets
• Assisted with SEPY, SPCT, SRCT, and PCAG reconfiguration of prefixes.
• Discovered system limitations and made solid recommendations to client to improve SDLC.
• Create new SPCR/QG/SRCR and SPCT prefixes
• Validate system updates of SPCR’s, SRCR’s, SRCT’s, SPCT’s, LTLT’s and QG’s

Supervisor/Clinical Business Unit

Confidential, Houston, TX

Responsibilities:

• Load medical definitions. Document benefits and medical definitions in Facets.
• Test benefits and pricing configuration and provide findings along with quantified data results of over/underpayments.
• Diminished process gaps by leading claims analysts to ensure optimal productivity
• Worked with ICD-10, NDC, CPT, HCPCS, SNOMED codes to resolve billing and coding issues Led cross-functional teams to analyze and understand enterprise-wide operational impacts and opportunities of technology changes
• Performed Medication Therapy Management with third party payers, pharmacists, and patients
• Planned and executed events and training programs
• Mapped process activities to identify shortfalls and identify options to rectify operational inefficiencies Reviewed performance data
• Evaluated consistency and importance of different BI data against needs to determine optimal courses of action
• Mapped current business and operational processes and initiated changes where needed
• Worked on Pharmacy billing and coding data-sets for claim processes