Experience

PPMSI

• Hospitals and Health Care
• 1 - 100 Employee

• Network Management Associate

  • Dec 2019 - Present



Zenith American Solutions, Inc.

• United States
• Insurance and Employee Benefit Funds
• 700 & Above Employee

• Requirements Analyst

  • Jun 2018 - Oct 2019

  Conducting discovery on new client configurations and internal claims system transitions, including discovery meetings. • Creation of requirements documentation including Visio workflows, business requirements documents, and requirements traceability matrices.• Interacting with internal resources to determine best approaches for systems integration.• Developing test cases within newly configured systems to prepare for launch of new client workflows. • Assisting the project manager office in implementation of new client workflows. • Creation of Visio workflows during discovery sessions to document current processes and Zenith processes. Show less

• Business Data Analyst (Business Automation)

  • May 2016 - Jun 2018

  • Created company-wide Office Innovator initiative, and lead team in identifying opportunities for business automation and improvement.• Designed workflows for project requests, customer service, claims, contribution accounting, and pension workflows on GetNext! platform.• Created Enterprise Data Strategy and worked to compile reporting methods into a universal data warehouse.• Acting as liaison and project manager for business automation department to multiple clients including Operating Engineers 3, SEIU 775, and ILWU.• Continuing to assist as Subject Matter Expert for Spyglass claims system transition.• Created and modified images via Photoshop for splash loading screens/logos for GetNext platform.• Analyzed trends in claims to determine areas for possible automation and process improvement.• Created training documentation for new workflows in the GetNext! document management tool.• Wrote company newsletter on innovation successes and business automation.• Designed splash screen for GetNext 2.0 proprietary platform.• Loaned temporarily to Coastwise Claims Office to develop new training programs and streamline processes for high priority Area Welfare Director requests. Show less

• Claims Technical Review Specialist

  • Apr 2015 - May 2016

  • Managing the eligibility team, acting as point of contact for eligibility issues with Blue Shield and Medicare Crossover.• Creating and formatting claims reports in SQL for internal requests and for clients.• Created and executed test cases for claims system transition, including User Acceptance Testing, Model Office Testing, and Ad-Hoc Testing.• Planning and coordinating office events, including fundraisers, charity drives, and holiday party.• Analyzing claims and eligibility reports in Excel, including creation of Pivot Tables and VBA Macros.• Training of new hires in claims processing and plan benefits• Created training materials for ICD10 transition and conducted nationwide training sessions for 13 offices.• Processing claims in various claims production queues, including review of claims processed with lower pay authority.• Working with variety of job tasks to improve business practices by developing new P&P's/DLP's, including litigation requests, subrogation, eligibility, claims processing, and training. Show less



Alameda Alliance for Health

• Hospitals and Health Care
• 200 - 300 Employee

• Provider Relations Representative

  • Jun 2014 - Mar 2015

  • Key player in the financial recovery of the company during the period of State-controlled conservator administration. • Creation of contracts for new providers and contract amendments for existing providers. • Identifying and researching a variety of issues related to provider contracting, compliance and operational issues. • Responsible for departmental restructure of Network Management and Provider Relations departments. • Developing and updating policies and procedures to streamline business processes. • Acting as liaison between departments to coordinate and resolve major provider issues. • Foster and maintain proactive relations throughout the provider network through face-to-face visits, phone calls, faxes and emails. • Identifying, directing, and researching provider operational issues for timely resolution. • Assessing the composition of the existing network, opportunities for expansion and the availability of services. • Recruiting both new providers for participation in the network and existing providers for new lines of business. • Providing coverage for main Provider Relations phone line and general mailbox. Show less



Ricoh USA, Inc.

• United States
• Information Technology & Services
• 700 & Above Employee

• Account Executive

  • Mar 2014 - Jun 2014

  • Sold hardware, software and professional services to small/medium sized businesses. • Used Salesforce to manage and update accounts. • Received training on multi-function printer devices, office workflow software, networking hardware and software, VoIP systems • Created quotes, pitched sales proposals to customers, and processed order paperwork. • Established new accounts via cold calling of customers on phone and in person. • Trained customers on use of hardware and software. • Sold hardware, software and professional services to small/medium sized businesses. • Used Salesforce to manage and update accounts. • Received training on multi-function printer devices, office workflow software, networking hardware and software, VoIP systems • Created quotes, pitched sales proposals to customers, and processed order paperwork. • Established new accounts via cold calling of customers on phone and in person. • Trained customers on use of hardware and software.



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Provider Services Representative/Subject Matter Expert

  • Nov 2004 - Nov 2013

  • Pricing extended market claims for Beechstreet, Multiplan, Care Trust Network, PHCS, MNRP, and FHG. • Updated Network Databases for contract additions, terminations, and changes for extended networks. • Subject Matter Expert for the Hospital Exceptions and Transactions Team. • Telecommute daily, working exclusively from home with no direct supervision. • Work directly with providers to resolve appeals and contract issues via phone and e-mail. • Training new team members on job tasks through in person training and web conferences. • Developing and implementing new reporting methods for production metrics and work queue backlogs in Excel. • Creating, editing and troubleshooting macros in Microsoft Excel to work with proprietary systems. • Pricing extended market claims for Beechstreet, Multiplan, Care Trust Network, PHCS, MNRP, and FHG. Show less



Concord Police Department

• Law Enforcement
• 1 - 100 Employee

• Community Specialist

  • Oct 2000 - Oct 2004

  • Worked at headquarters front desk and community field offices, assisting public with questions and concerns. • Wrote detailed police reports on low-priority non-violent crimes. • Assisted in training new employees at headquarters front desk. • Compiled crime statistics for neighborhoods and presented statistics to public citizens. • Implemented and managed public citizen LiveScan fingerprinting program. • Handled non-emergency and 911 emergency calls in Concord Police Dispatch center. • Relayed information to Officers on radio for active police incidents. Show less



C & J Kreins Tax Service

• Concord, CA

• Administrative Assistant

  • Feb 1998 - Apr 2004

  • Answered phone calls, scheduling appointments and answering basic income tax questions. • Assembled tax returns for clients, handling tax documents. • Collected payments from clients upon pickup of finished tax returns. • Answered phone calls, scheduling appointments and answering basic income tax questions. • Assembled tax returns for clients, handling tax documents. • Collected payments from clients upon pickup of finished tax returns.