Experience

UPMC Enterprises

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Data Communications Specialist

  • May 2022 - Present



UPMC

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

• Operations Analyst

  • Dec 2016 - May 2022

  < Configures, updates and maintain the main transactional processing system in a timely and professional manner to meet and exceed customer needs.< Supports operations as they relate to member satisfaction, retention, revenue growth, workflow efficiency, and transparency.< Works with IT to implement new MC400 merge environment and begin system modernization.< Provides ongoing troubleshooting, support and maintenance of transactional system- based data and configuration; including conducting regular information audits and communicating results to the customer and IT communities.< Continuously adjusts Visio workflows and processes for MC400 Support System, ID Card System based upon business needs or organizational changes.< Model business requirements for new systems, special projects, and enhancements to existing systems,validate and test fixes/enhancements to new and existing systems. < Identify areas of concern that may compromise client satisfaction through data analysis, and proposes solutions based on findings, expertise and research.< Manages, updates, and maintain source data dictionaries as they relate to processes. < Complete instructions and training for peer department on the use of new MC400 Security request forms. Show less

• Enrollment Specialist

  • May 2014 - Nov 2016

  < Conducted thorough and detailed root cause analysis on enrollment issues and incoming inquiries to the health plan Medicare customer service team.< Identified and implemented improvements in CMS LEP process. Recognized and reported trends and issues of concern.< Performed routine reconciliation activities to ensure LEP enrollment data was accurate and compliant with federal regulations. Reviewed and resolved data discrepancies in demographics, special statuses, and enrollment statuses driving efficiency and quality.< Identified areas of opportunity to improve service to members and/or reduce member impact. < Developed a Genesys Call Scripter to expedite the flow of customer calls.< Performed specialized, product-specific reporting shared with Sr. Leadership to support workflow improvements increasing accuracy and improved staff productivity.< Served as team lead subject matter expert, creating and administering training and executing team communications.< Proposed new solutions for compliance adherence, monitoring, and process improvements. Show less