I successfully leveraged Power BI and Excel for data analysis and performance measurement, enhancing decision-making accuracy by 20% and delivering 100% on-time project completion using detailed burndown charts. I also spearheaded cross-functional Medicare and Retirement implementation and migration projects, ensuring timely delivery by overseeing project documentation, managing scope, and adhering to escalation protocols.𝙈𝙮 𝙎𝙞𝙜𝙣𝙖𝙩𝙪𝙧𝙚 𝘾𝙤𝙣𝙩𝙧𝙞𝙗𝙪𝙩𝙞𝙤𝙣𝙨 𝙄𝙣𝙘𝙡𝙪𝙙𝙚:• Oversaw provider risk deals, managed post-migration activities, maintained PMA issue logs, and produced final project reports, achieving 90% stakeholder satisfaction.• Spearheaded business process management initiatives to improve operational efficiency and streamline workflows.• Conducted comprehensive stakeholder analysis, facilitated governance processes, managed change requests, and captured requirements to align project scope with objectives.• Led kickoff and weekly status update meetings with leadership and stakeholders, crafted project schedules and process flowcharts, resulting in a 95% compliance rate.

I effectively led a team of four in executing contract configuration loads for Medicare and Retirement implementation and migration projects across multiple platforms, maintaining a 98% accuracy rate and 100% validation success rate. I also collaborated in kickoff meetings and Joint Application Development (JAD) sessions to define project goals, gather requirements, and design solutions.𝙈𝙮 𝙎𝙞𝙜𝙣𝙖𝙩𝙪𝙧𝙚 𝘾𝙤𝙣𝙩𝙧𝙞𝙗𝙪𝙩𝙞𝙤𝙣𝙨 𝙄𝙣𝙘𝙡𝙪𝙙𝙚:• Regularly participated in weekly stakeholder meetings, providing project updates, addressing concerns, and ensuring alignment with timelines.• Partnered with IT, operations, and compliance teams to troubleshoot issues, optimize workflows, and ensure data integrity.• Delivered data analysis reports, presented key metrics, and maintained consistent stakeholder communication.

As a Provider Installation Specialist I played a critical role in managing special projects to update provider information, addressing claims processing issues, corrections, or terminations.𝙈𝙮 𝙎𝙞𝙜𝙣𝙖𝙩𝙪𝙧𝙚 𝘾𝙤𝙣𝙩𝙧𝙞𝙗𝙪𝙩𝙞𝙤𝙣𝙨 𝙄𝙣𝙘𝙡𝙪𝙙𝙚:• Processed and loaded provider contracts for hospitals, ASCs, SNFs, dialysis centers, hospices, and clinics.• Verified contract details and facilitated corrections when discrepancies were identified, ensuring contract accuracy.

Provided expertise or general C&S claims support by reviewing, researching, investigating, and resolving Florida and Rhode Island Medicaid provider admin and clinical claim appeals. Determined root causes for claim denials and underpayments. Processed adjustments in COSMOS when business required

Reviewed E&I pre-authorization claims cases submitted by providers and members and render a coverage determination based on contract provisions and exclusions. Conducted research and render decisions on gap cases using info and tools to locate providers including but not limited to physicians, skilled nursing facilities, outpatient facilities, etc