Objective:

Seeking a challenging and rewarding Information Technology position with the potential to evolve into a management role. Interested in opportunities to utilize extensive analytical, leadership, and customer relations experience within a solid progressive company.

Software/

System Skills: EVC, FileNet, SilkCentral Test Manager, SharePoint, PEGA, DB2, SQL, Java, Oracle, Test Pro, CATTS, Meditech, CMS Supervisor, Avaya, Navicure, Nextgen, MMIS, Project Invision, ITIL, Enterprise Change Management, Telnet TSO , SAPGUI, HOST Accounting, Symposium, Sentinel, Windows all versions , PowerPoint, Excel, Electronic Mail Lotus Notes Outlook , and Internet

Work Experience

Confidential

• Analyzed and documented complex NC Medicaid business requirements and processes for the Early Implementation Operations Unit communicated these requirements to appropriate management staff and clients in a professional manner.
• Defined and assisted with implementing systematic changes per the specifications of the customer, while presenting a formal business solution of the results after performing system testing via User Acceptance Testing utilizing Test Pro.
• Provided input into developing and modifying business requirements to meet client needs. Developed business specifications to support these modifications.
• Developed, wrote and implemented systematic procedures, operations manuals, and business process documents initiated from Customer Service Requests to ensure efficient business activities while utilizing Sharepoint to secure and store collected data.
• Coordinated and facilitated meetings with clients while assisted with training staff and clients regarding system modifications.

Systems Business Analyst

Confidential

• Active liaison between the Division of Medical Assistance and technical solutions/support groups in order to identify business processes, systems, and product requirements related to the impact of the National Provider Identifier to the NCMMIS .
• Identified and defined the specific activities that must be performed to produce the deliverables identified in the project breakdown structure in order to meet the customer's objectives. Analyzed activities while managing the project schedule from start to finish utilizing Project Invision and utilized SAP as the change management system.
• Developed, documented and obtained customer approval of business requirements while creating Systems Life Cycle documents detailing the customer's specifications and project timelines.
• Maintained knowledge and understanding of the system functionality, provider-filing requirements while assessing the impact of any NPI related systems changes to overall claims adjudication and payment.
• Defined, tested, and implemented updates to business systems such as, Oracle SQL databases per the specifications of the customer, while presenting a formal business solution of the results after performing system testing via User Acceptance Test.

Provider Services Call Center Team Lead

Confidential

• Supervised 20 telephone analysts and provided managerial support to the NC Medicaid Provider Services Call Center Help Desk.
• Developed and designed manuals for daily Call Center processes.
• Educated and trained telephone analysts on updates to various NC Medicaid Programs and medical claims analysis processes.
• Educated and trained providers on the accurate procedures of submitting claims while ensuring the most successful customer service is received.

Patient Financial Counselor

Confidential

• Processed a minimum of 100 insurance claims on a daily basis while maintained monthly denial reports.
• Primary collection agent for the practice while interfaced with various outside collection agencies to maintain A/R on a monthly basis.
• Maintained and balanced cash drawer on a daily basis while performed checkout desk duties along with collected patient payments.

Senior Provider Relations Specialist

Confidential

• First line responder of over 200 phone calls on a daily basis from providers and optical insurance policy holders.
• Investigated claim inquiries and resolved in depth claim denials via web-based program.
• Initiated insurance claim appeals proceedings and responded to appeal decisions via correspondence.

Quality Assurance Analyst

Confidential

• Monitored and evaluated Patient Account Specialist telephone calls on a daily basis for accuracy, professionalism, and quality customer service.
• Compiled and analyzed data from audit results for reporting to Corporate Management and Call Center Supervisors.
• Provided extensive training and coaching to employees to improve customer service skills.

Patient Account Specialist

Confidential

• Provided first line system support to hospital patients and vendors.
• Initiated research to provide quality assistance, processed correspondence received within the hospital mailrooms, and resolved patient account payment issues.

Customer Service Specialist

Confidential

• Verified medical insurance benefits for over 200 members and providers via telephone on a daily basis while providing accurate and professional customer service.
• Investigated claim status inquiries and assisted with medical underwriting processes while responding to insurance premium questions and concerns.

Human Resources Coordinator Assistant Contractor

Confidential

• Assisted the Human Resource Coordinator with administrative duties and maintained organization of
• the office.
• Administered pre-employment screenings to access applicant's competency for employment.