Provider Data Reporting Analyst

• Aug 2018 - Present

Responsible for completeness and accuracy of routine production and ad-hoc data reporting required for internal and external customers Work closely with all customers in order to understand the business need and interpret the business purpose of the reports Support all regulatory reporting requirements, meeting deadlines while satisfying all required components Responsible for completeness and accuracy of routine production and ad-hoc data reporting required for internal and external customers Work closely with all customers in order to understand the business need and interpret the business purpose of the reports Support all regulatory reporting requirements, meeting deadlines while satisfying all required components

Client Setup Analyst

• Dec 2016 - Mar 2018

Business Analyst

• Jun 2012 - Dec 2016

Lead the development and maintenance of the reimbursement system; expedite the resolution of complex issues and maintain continual functionality. Produce detailed material for internal and external audits and review audit findings / reports to ensure accuracy / completeness; presents solutions and recommendations.• Lead the evaluation and analysis of various claim payment issues, including underpayments and overpayments; uncovers new reimbursement issues or opportunities and develops key action plans• Define business requirements, lead testing initiatives, develop comprehensive project plans, conduct presentations, perform system testing, and create test scenarios for new system debugging efforts• Serve as a direct resource for cross-functional analysts; establish, introduce, and implement new desk procedures and design, develop, and deliver training courses; increase performance / potential

Provider Data Coordinator

• May 2007 - Jan 2012

Provided expert-level support to Blue Core team members; influenced changes to business and validation rules to enter a new add / change within the CPR system. Streamlined the production of provider directories throughout all units. Evaluated / investigates claim suspensions from contracting / non-contracting providers.• Identified the root causes of issues in the Magellan monthly file and coordinated meetings with Magellan to review and recommend new data elements necessary to maximize usage of the full file• Coordinated and led activities involving new and existing facility and ancillary provider demographic data across all product lines; maximized overall process efficiency and prevented key system issues

Provider Data Specialist

• Dec 2005 - May 2007

Efficiently processed facility providers for Administrative Service Operations and conducted detailed quality evaluations of new and existing provider business accounts to ensure accuracy and completeness; proactively identified and resolve complex issues. Investigated, resolved, and processed complex provider modifications.• Instrumental in the development and implementation of policies and procedures for Region 19 and Kentucky business operations; introduced new procedures and seamlessly executed new strategies

Electronic Data Information Specialist (EDI)

• Apr 2003 - Dec 2005

Efficiently processed group and member enrollment transactions, including new applications, recent and existing group accounts, changes, student and handicap verifications, and terminations. • Researched and analyzed providers for PCP assignment• Processed sensitive group and member accounts in MHS and Legacy• Distributed enrollment packages to prospective members