Experience

Health Partners Plans

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Managed Care Reimbursement Analyst

  • Aug 2015 - Present

   Research, analyze, and audit fee schedule data to ensure system accuracy  Create and implement new fee schedules based on contract language  Research and resolve complex fee schedule issues  Understand and interpret contracts for new system configuration  Financial analysis for managed care contract negotiations and fee schedule adjustments  Ability to navigate and monitor government websites (CMS, DHS) for rate file releases  Ability to understand and interpret reimbursement via EncoderPro, 3M Grouper Software, and HealthRules Payor.  Determine compensation and develop various reimbursement models for Health Partners’ lines of business using Medicaid, Medicare, and other reimbursement methodologies as a basis for recommended payments



TMG Health

• Hospitals and Health Care
• 300 - 400 Employee

• Business Systems Analyst

  • Nov 2014 - Aug 2015

   Business Requirements gathering and documentation  Deep dive into new Medicaid client contract  Work collaboratively with configuration analysts and team leads to create and define benefit grids  Business Requirements gathering and documentation  Deep dive into new Medicaid client contract  Work collaboratively with configuration analysts and team leads to create and define benefit grids



Independence Blue Cross

• United States
• Insurance
• 700 & Above Employee

• Sr Business Analyst

  • 2008 - 2014

   Analyze, and validate professional provider system benefit pricing set-up for contracts Timely and accurate resolution of systemic service code set-up and system edits  Identifying and assuring appropriate modifier mapping to specific providers fee schedules based on contractual provisions Participate in various projects and initiatives as requested Support and provide enhancements to the internal systems and maintain accurate relationships to the various platforms dependent upon provider data Collaboratively created business requirements for the provider information systems team (I.S.) and testing the initiatives to validate accurate connections and response Conduct audits at regular intervals to validate correct provider data and facilitate changes as necessary Navigate and monitor government websites (CMS, DHS) for rate file releases  Research, analyze, and audit fee schedule data to ensure system accuracy Create and implement new fee schedules based on contract language

• Business Analyst

  • Jan 2006 - May 2008

   Review and analysis of professional provider demographic record set-up with use of daily demographic file feeds, and weekly audit and disconnect reports Assisting in the updating of business requirements used for running audits and system enhancements Performing quality check of audit output information to ensure accuracy in provider demographic and contract (fee schedule) setup Working with Provider IS on automation process of provider demographic set-up to reduce the need for manual intervention