Onsite Consultant Resume

SUMMARY:

Medical Plan configuration, manipulating service procedure, service revenue, supplemental procedure, supplemental revenue, medical utilization edits, service payment, limits, service rules, benefit summary, and class plan tables.
Create back end data loads through Access to upload tables into Confidential system.
Retrieve data through table queries within Confidential .
Build dental products and all associated tables within Confidential .
Appointed as Lead for the self - insured line of business.
Work closely with Sales, interpreting benefits sold into business decisions and system configuration.
Oversaw implementation with Confidential consultant for a year; revamping and implementing preventive and mental health configuration, working daily through conference calls, providing business decisions and reviewing completed work before going to production.
Work closely with onsite physicians and nurses to discuss issues regarding coding, medical and regulatory guidelines, pricing and non-covered benefits.
Work with certified coders and served on an internal coding committee addressing billing and coding issues.
Test, load and configure business decisions into system.
Team lead for recent upgrade of Confidential system.
Test and implement quarterly fixes to Confidential .
Organized meetings with all department management to review benefits in depth discussing the payment type, coding and pricing before implementing Confidential configuration.

PROFESSIONAL EXPERIENCE:

Onsite Consultant

Confidential

Responsibilities:

Interpreting dental plans and business decisions into system configuration.
Prepared documentation and reference materials for team members for future reference of Confidential configuration setup.
Work closely with onsite physicians and nurses to discuss issues regarding coding, medical and regulatory guidelines, pricing and non-covered benefits.
Work with certified coders and served on an internal coding committee addressing billing and coding issues.
Test, load and configure business decisions into system. Team lead for recent upgrade of Confidential system.
Test and implement quarterly fixes to Confidential .