Perform moderate to complex configuration activities within the QNXT system and take responsibility for developing an extensive expertise in the QNXT Administration and Configuration portals and the third party applications supporting the system. Coordinate and maintain assigned member facing QNXT components for the program and play a key role in configuration and support of existing and new lines of business. Maintain QNXY medical codes, finance codes, system configuration for benefit plans,… Show more Perform moderate to complex configuration activities within the QNXT system and take responsibility for developing an extensive expertise in the QNXT Administration and Configuration portals and the third party applications supporting the system. Coordinate and maintain assigned member facing QNXT components for the program and play a key role in configuration and support of existing and new lines of business. Maintain QNXY medical codes, finance codes, system configuration for benefit plans, organizational and medical policies, benefit application analysis, contracts, CES testing and documentation. Responsible for understanding business goals and translating them into configuration requirements. Perform data analysis and draw business conclusion for decision making. Identify key components of a project and evaluate the impact across the organization. Understand all aspects of program operations, including policies and procedures, program guidelines, file layouts and requirements, general rules and regulations in order to exercise good judgment in the use of configuration standards. Maintain and support claims as assigned, including stand-alone software systems and QNXT functionality. Create complex design documents through the assessment of requirements; assess alternatives to different designs and choose best solution to fit business needs. Create, understand and articulate data regarding program operations. Show less

Serve as Subject Matter Expert interface between Benefits Administration and the Clinical team in the development of clinical programs and formulary management changesProvide Benefit Administration related build and maintenance support for assigned clinical programsRepresent Benefit Administration in working with the Clinical team on clinical requirements development and deploymentServe as a skilled clinical resource in support of non-clinical team membersIdentify the common… Show more Serve as Subject Matter Expert interface between Benefits Administration and the Clinical team in the development of clinical programs and formulary management changesProvide Benefit Administration related build and maintenance support for assigned clinical programsRepresent Benefit Administration in working with the Clinical team on clinical requirements development and deploymentServe as a skilled clinical resource in support of non-clinical team membersIdentify the common causes of defects, prioritize them and systematically remove defects to avoid recurrences in further development workWork with Clinical team to understand the customer’s product-specific requirements and configuration and translate them to benefit technical design specifications and data flow from which programs are developed and codedCode, test, debug, implement and document for programs or technical configurationInteract with Clinical and IT development teams during the software build or configuration testing processPerform technical application configuration and produce formulary based benefit related reports at user requestDesign and execute unit, system and integration test plans for new formulary based benefit related developments/releases/reportsMaintain formulary related technical documentation based on standard operating procedures in support of the assigned clinical applicationAssume complete ownership for the assigned tasks and communicate the progress of the project plan/task to all stakeholders regularlyDemonstrate an understanding of end users business needs and work closely with end users to identify problems and provide solutionsRequest system enhancements as a need for process improvement Show less

Extensive client interaction, benefit configuration, plan coding in FirstRx application, peer training, peer coding/documentation review, collaboration with clinical manager, account manager, data integration group, CORE and call center resources to address client requests, claim analysis, plan analysis, production patch testing, meticulous documentation and analysis skills, maintain high volume client as well as one other client, proficient in formulary management, create and submit… Show more Extensive client interaction, benefit configuration, plan coding in FirstRx application, peer training, peer coding/documentation review, collaboration with clinical manager, account manager, data integration group, CORE and call center resources to address client requests, claim analysis, plan analysis, production patch testing, meticulous documentation and analysis skills, maintain high volume client as well as one other client, proficient in formulary management, create and submit application change requests, proficient in CRM, proficient in Microsoft Word and Microsoft Excel, fluent in CCM testing, work with quality control resources to trouble-shoot and evaluate reported issues from CCM testing Show less

Ensured patients had correct lab results when promised, contacted accounts to gather information that was missing from requisition form, fax doctor’s offices with results, ensured HIPAA compliance, accessioned on a full time basis at Henrico Doctor’s and St. Mary’s Hospital, trained new employee for hospital procedure, multi-tasked general office duties such as answering telephone lines, composing e-mails, completing patient forms and preparing documents for the laboratory

Ensured HIPAA compliance, provided patient education, made proper conversions for antibiotic dosing, trained staff on new procedures, maintained patient privacy and confidential patient information, interviewed patients to obtain pertinent medical information, multi-tasked general office duties such as answering multiple telephone lines, completing insurance forms and preparing documents for patients, performed monthly inventory and maintained pharmacy supply counts.