Experience

Elevance Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Director

  • Mar 2022 - Present

  • Successfully developed a commercial capitation leakage process and workflow document and developed an automated reported for the VBS Operations team to review on a daily basis; ensuring no to little leakage occurs and appropriate measures are taking to avoid leakage. • Work with the providers if questions arise related to their capitation contract for capitated services. • Responsible for data modeling reports showing financial and traditional leakage, market trend information based on… Show more • Successfully developed a commercial capitation leakage process and workflow document and developed an automated reported for the VBS Operations team to review on a daily basis; ensuring no to little leakage occurs and appropriate measures are taking to avoid leakage. • Work with the providers if questions arise related to their capitation contract for capitated services. • Responsible for data modeling reports showing financial and traditional leakage, market trend information based on membership and cost, and other financial transactions for contracted capitated providers. • Supports Government Business Division (GBD) capitation leakage project that includes running queries for numerous Medicare and Medicaid markets, analyzing the data, providing a business solution, and coordination and managing meeting if needed with the teams or providers. • Successfully developed a GBD leakage recovery process, working with Legal and provider communications to create provider facing documentation. This process also includes working with contracting team and providers, explaining the data and process for recoupment overpayments and presenting to leadership on the leakage recovery process. • On track for implementing a process to pay Medicare capitated providers using several inhouse payment systems with a scheduled go-live in late 2023. • Assisted in writing and maintaining the commercial and GBD DOFR (Division of Financial Responsibility) documentation for capitated contracting. • Tracking and maintaining IT GBD projects, along with presenting processes and statuses of projects to leaders • Leads a bi-monthly meeting to all GBD markets about capitation learning sessions, process end to end sessions with multiple supporting teams, that includes process improvements strategies. • Leads a re-contracting negotiation rate reporting effort for new and existing capitated providers Show less



Amerigroup

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Business Analyst

  • Oct 2013 - Present

  Nashville TN • Team leader for several business analysts • Responsible for developing and maintaining numerous Behavior Health Department SQL variable reports • Modified code for previously written business reports for operational purposes • Analyzed business requirements for reports and create best practices related to healthcare operation • Interpreted and created business requirements documents based on the state regulatory guidelines and contract documents. • Thoroughly tested and… Show more • Team leader for several business analysts • Responsible for developing and maintaining numerous Behavior Health Department SQL variable reports • Modified code for previously written business reports for operational purposes • Analyzed business requirements for reports and create best practices related to healthcare operation • Interpreted and created business requirements documents based on the state regulatory guidelines and contract documents. • Thoroughly tested and approved developed Regulatory Compliance Reporting reports prior to moving to production, testing report components • Researched and corrected provider system data • Interacted with other departments ensuring provider network adequacy statewide, as required

• Business Info Consultant Sr

  • Jun 2017 - Mar 2022

  Nashville, Tennessee Report developments continues, as in the previous position , lead IT projects. • Led reporting analyst team ensuring the integrity of provider facing Metrics and KPIs from 2017-2022 • Managed the development of reports relating to provider data, claims/authorization remediation, network reporting and provider records support • Resolved operational issues, established key performance indicators to facilitate accountability and improved data quality • Managed and developed Regional… Show more Report developments continues, as in the previous position , lead IT projects. • Led reporting analyst team ensuring the integrity of provider facing Metrics and KPIs from 2017-2022 • Managed the development of reports relating to provider data, claims/authorization remediation, network reporting and provider records support • Resolved operational issues, established key performance indicators to facilitate accountability and improved data quality • Managed and developed Regional and State reporting for multiple Anthem Medicaid/Medicare markets • Team responsibly for developing and maintaining numerous health plan SQL and Oracle variable and temp table reports • Created numerous SSAS databases for report automation using a SSIS package • Created and maintained a several Business Intelligent Analytical databases to house numerous complex automated reports using SSRS and Tableau • Maintained several Regulatory reports, deciphered requirements and testing with Regulatory IT partners; ensuring no liquidated damages • Developed and overseeing training materials for BI report development and automation procedures • Managed and supported Regulatory report development, projects related to Opioid, Behavioral Health, Provider Directories, internal SDLC report development supporting multiple health plan departments, etc.



Tennesse Army National Guard

• Retired

  • May 1997 - May 2018

  RTI-Smyrna Staff Sergeant- Assist in maintaining over a million dollars of aviation logistic supplies and inventory management in support of military training and missions, along with generate reports Maintain soldiers in Unit in assurance that the unit maintain its required personnel strength level and that soldiers receive all or additional benefits offered throughout their military career Lead formal and informal training presentations on job-skills and performance expectations. Developed… Show more Staff Sergeant- Assist in maintaining over a million dollars of aviation logistic supplies and inventory management in support of military training and missions, along with generate reports Maintain soldiers in Unit in assurance that the unit maintain its required personnel strength level and that soldiers receive all or additional benefits offered throughout their military career Lead formal and informal training presentations on job-skills and performance expectations. Developed several MS Access database reports and ad-hoc queries to improve the efficiency of ordering and receiving supplies. Show less



Community Health Systems

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Application System Analyst

  • Feb 2013 - Oct 2013

  McKesson HCI Analyst and iForms development. Programming languages- HTML, JavaScript, and VGR • Develop online medical iForm by HTML and Java for added functionality • Develop external linkable Cascading Style Sheet for iForms -Monitor multiple server statuses that includes, HCI, HCA, HPP, etc. -Perform maintenance on servers as needed, such as stopping and/or restarting, working closely with other L2/L3 server support teams -Coordinating patch maintenance with… Show more McKesson HCI Analyst and iForms development. Programming languages- HTML, JavaScript, and VGR • Develop online medical iForm by HTML and Java for added functionality • Develop external linkable Cascading Style Sheet for iForms -Monitor multiple server statuses that includes, HCI, HCA, HPP, etc. -Perform maintenance on servers as needed, such as stopping and/or restarting, working closely with other L2/L3 server support teams -Coordinating patch maintenance with Vendor -Performing bi-annual daylight savings time updates for McKesson HCI servers -Perform application security by creating users, building department, maintaining system user roles and resetting passwords. -Reading and interpreting Unix system error logs

• IT System Analyst

  • Nov 2011 - Oct 2013

  Brentwood, TN IT Change Management Develop Change Management Process training documentation and facilitated process training sessions Perform Remedy Change Management system support for both corporate and facilities employees Develop numerous Change Management Metrics Reports for executive management Change Advisory Board (CAB) member and facilitated CAB meeting Maintain Change Management Intranet Webpage Received ITIL v3 Training and Certification



ZYCRON, INC/BRIDGESTONE AMERICAS HOLDING

• SAP Technical Coordinator Consultant

  • Aug 2008 - Jun 2010

  Greater Nashville Area, TN •Created Pre-implementation, Implementation, and Post-Implementation documents such as Business Requirement, Unit Test/User Acceptance Test, Migration Plan documents •SAP Change Coordinator for all configuration and technical changes affecting system’s production that included business process verification and review, writing business requirements, test plans, and presenting before CAB for system upgrades and weekly business request•Verified business requests by manual testing in multiple… Show more •Created Pre-implementation, Implementation, and Post-Implementation documents such as Business Requirement, Unit Test/User Acceptance Test, Migration Plan documents •SAP Change Coordinator for all configuration and technical changes affecting system’s production that included business process verification and review, writing business requirements, test plans, and presenting before CAB for system upgrades and weekly business request•Verified business requests by manual testing in multiple SAP systems, such as the sandbox, development, and quality and documented error findings•Communication lead for the SAP Annual Maintenance technical project, creating and providing documentation to the business and Bridgestone’s Change Advisory Board (CAB) - Created and documented monthly audit material for SAP Competency Center (CC), querying data selection based on business and/or management request using MS Excel and Crystal Reports from SAP or Remedy systems in conjunction with the SAP Security team for improved quality control and compliancy methodologies •Maintain and analyze several Bridgestone’s tire management systems by creating and generating reports using MS Access in support of daily business needs •Assisted, triaged, or resolved SAP support calls, emails using Remedy Request Services that included Incident Management and Change Management for the SAP CC team •Created process decision trees for BFUSA Service Desk/SAP conversion for improved management of SAP services •Train SAP teammates on using Remedy for better customer service support and developmental request improvements •Maintained new BFUSA SAP CC intranet website characteristics and contents, along with administered all internal SAP shared drives •Assisted in RWD uPerform management for establishing training documents guideline and procedures and analyzed business critical terms as uPerform’s glossary administrator Show less



Bridgestone Americas

• United States
• Motor Vehicle Manufacturing
• 700 & Above Employee

• SAP Business Process Internship

  • Jun 2007 - Aug 2008

  • Gather and document business processes on how other companies utilized SAP ERP system for improvements such as fully learning utilizing SAP business functionalities and Business Process Leaders (BPL) support at offsite locations • Assisted in HP Quality Center Project’s configuration and development as a SAP testing tool, with experience in creating and generate automatic testing script processing and training the SAP team on HP Quality Center and Quick Test software • Assisted with… Show more • Gather and document business processes on how other companies utilized SAP ERP system for improvements such as fully learning utilizing SAP business functionalities and Business Process Leaders (BPL) support at offsite locations • Assisted in HP Quality Center Project’s configuration and development as a SAP testing tool, with experience in creating and generate automatic testing script processing and training the SAP team on HP Quality Center and Quick Test software • Assisted with training of several SAP business modules SAP Finance, Purchasing, Plant Maintenance • Assist in the preparation of RWD uPerfom deployment, defined uPerform’s Standards and Guidelines, and maintaining uPerform’s glossary as an administrator • Created and managed SAP team Email Distribution Lists for estimated 2100 users using MS Exchange Server Show less



HARRISON COUNTY SHERIFF DEPARTMENT

• Records Clerk/Office Assistant/Dispatcher

  • Apr 2003 - Oct 2005

  Managed data within a law enforcement database, enabling deputies to research criminal information; performed criminal background checks.



Convergys

• Customer Service Representative

  • Sep 2002 - Mar 2003

  Provided customer service, updating and maintaining customer accounts as well as assisting customers with online orders.



USM OFFICE OF TECHNOLOGY RESOURCES

• Web/Course Designer

  • Aug 2001 - Sep 2002

  Web Team Personnel/ WebCT Course Developer for PeopleSoft Developed and presented WebCT training courses for faculty and staff. Implemented updates and user changes to the USM website S. Applewhite1



PETAL HIGH SCHOOL

• Web Designer/Consultant

  • Dec 2001 - May 2002

  Taught basic HTML and designer techniques to students, along with editing and publishing web pages online.