Healthcare Analyst

Healthcare Analyst

• Jan 2010 - Present

Licensed professional counselor enrollment initiative. This project start up was to set up procedures for enrolling600 licensed professional counselors. Process included taking enrollees phone calls to answer enrollment questions. Viewing enrollment applications and verifying license , NPI, CAQH (adding to BCBS roster with CAQH) Medicare compliance (S3). Enrolling applicants. • BlueCard Claims area MRR database project. Outreach to over 100k providers and practitioners to improve claims processing efficiency. Project included coordinating with internal consultants throughout Michigan along with their counterparts at larger Hospital corporations. • Freestanding Radiology Center enrollment: Outreach to over 300 pre-qualified radiology centers via phone and email , application process and enrollment of radiology centers. Verifying Medicare compliance , Insurance , Accreditation , License. • Death Master database purge. Project required using internet outreach/search to confirm practitioners death/retirement status. Purging from database once confirmed. • NPDB data pull for credentialing department process of healthcare practitioners • Responsible for assisting with the processing of practitioner applications for credentialing and re- credentialing by performing primary source verification of all credentialing elements. • Develop Procedures, QC, train and monitor the progress on a 383,000 record clean-up of which, 45,092 records required manual intervention and at the end of the project 92% of those has been completed. This had a direct effect in improving our overall data quality and has become the foundation for future processes. Show less

Account Supervisor

• Jan 2009 - Jan 2010

This assignment has me assisting with the verification and auditing of New York state government employees for purposes of health insurance. • Duties include monthly Service observed, monthly performance reviews and scheduling. Occupancy and Service level monitoring throughout the day. • Systems used- CMS , SOV, Blue Pumpkin Director enterprise, Instant Retrieval, Real Time Monitor, Excel, Outlook, Word This assignment has me assisting with the verification and auditing of New York state government employees for purposes of health insurance. • Duties include monthly Service observed, monthly performance reviews and scheduling. Occupancy and Service level monitoring throughout the day. • Systems used- CMS , SOV, Blue Pumpkin Director enterprise, Instant Retrieval, Real Time Monitor, Excel, Outlook, Word

Training Coordinator

• Jan 1993 - Jan 2003

Trained new hires to operate Federal Moguls proprietary windows based system. Operated as their supervisor during probationary period. • Handled orientation for Federal Mogul’s customer service employees. (Human Resource Policy) • Supplied required remedial training and floor support to agents. • Assisted in the institution of ISO 9000 and provided instruction to all non-management employees. • Coordinated ramp up and training of Customer Service department and new hire training and on-going coaching. Show less

Supervisor/Team Coordinator and Trainer

• Jan 1993 - Jan 1998

Assist agents with UAL system and handle escalated calls. • Training Assistant special assignment: Train new hires in UAL policy and procedures. Explain proprietary computer system. Assisted with on the job training during probationary period. Assist agents with UAL system and handle escalated calls. • Training Assistant special assignment: Train new hires in UAL policy and procedures. Explain proprietary computer system. Assisted with on the job training during probationary period.