Anna G. Email & Phone Number

West Warwick, Ri, Us

Providence, Rhode Island, United States

Responsible for a full range of activities that ensure the overall effectiveness and excellence of RIQI’s core functions and services. With a focus on product support and process improvements that involve the design, testing, and implementation of new or enhanced products and services.• Perform task work needed to document operational processes and procedures for newand existing products and services.• Perform analysis work and making recommendations to improve specific… Show more Responsible for a full range of activities that ensure the overall effectiveness and excellence of RIQI’s core functions and services. With a focus on product support and process improvements that involve the design, testing, and implementation of new or enhanced products and services.• Perform task work needed to document operational processes and procedures for newand existing products and services.• Perform analysis work and making recommendations to improve specific operationalwork processes. • Provide analytical support for the rollout of new features and improvements for variousproducts and services.• Reporting for the RHIO state deliverables and department monthly metrics. Show less

Providence, Rhode Island Area

Assisted the Director and department manager in designing business processes and operational workflows for the CurrentCare, CurrentCare for Me, Care Management and Statewide Provider Directory products. • Subject Matter Expert (SME) on the Care Management Panel process• Analyze files submitted by our data sharing partners for upload to our product databases. • Reporting for the Operations monthly metrics and CurrentCare Enrollment quarterly presentation• Train staff on new… Show more Assisted the Director and department manager in designing business processes and operational workflows for the CurrentCare, CurrentCare for Me, Care Management and Statewide Provider Directory products. • Subject Matter Expert (SME) on the Care Management Panel process• Analyze files submitted by our data sharing partners for upload to our product databases. • Reporting for the Operations monthly metrics and CurrentCare Enrollment quarterly presentation• Train staff on new and updated products to ensure consistent processing within the department.• Perform quality control on Operations staff and made recommendations for improvement with the department’s current processes. • Participate in the development of accurate test plans and analyzed the results of those tests. • Collaborate with internal and external stakeholders and business partners. • Communicate and interact closely with IT developers and operations staff. • Created a new format for departmental procedures that included hyperlinks and screenshots. • Subject Matter Expert (SME) on specialty code mapping for the Statewide Provider Directory. Show less

Providence, Rhode Island Area

Accepted into the Tech Force Rhode Island grant program. Attended career workshops to work on my resume and job interview skills.

Providence, Rhode Island Area

Previously Perot Systems, Dell acquired this division in 2009.Analyzed and tested policy and benefit system changes for the Blue Cross Blue Shield of Rhode Island account. Maintained the “orbit” report consisting of claims in unpaid check status. Performed database maintenance for health service and diagnosis codes. Created templates and training documents for team. • Led the “orbit” report team in researching, identifying and reporting unpaid claims for clients. The report claim… Show more Previously Perot Systems, Dell acquired this division in 2009.Analyzed and tested policy and benefit system changes for the Blue Cross Blue Shield of Rhode Island account. Maintained the “orbit” report consisting of claims in unpaid check status. Performed database maintenance for health service and diagnosis codes. Created templates and training documents for team. • Led the “orbit” report team in researching, identifying and reporting unpaid claims for clients. The report claim count reduced from 1600 to 0. • Lead tester for the Blue Cross Blue Shield of Rhode Island’s CVS account. Created and ran the testing for the annual benefit updates and audit. • Identified a major project issue with system coding prior to production that saved countless hours of additional claim adjustments. • Created an Excel testing spreadsheet and several Word templates to aide team in reducing the test create time by 50%. • Contributed to the Claims Triage team by researching and organizing the phone calls tracked through the Remedy ticket system. This freed the systems department to work only the calls related to actual systems issues. • Contributed to the Policy team by attending meetings and providing input on claims research and testing on upcoming policy changes. • Performed research, testing and database maintenance on health service and diagnosis codes allowing customer expectations to be clarified prior to production uploads.• Wrote several Microsoft Word training documents for Configuration Analysis team saving valuable time when training future team members. Show less

Providence, Rhode Island Area

BCBSRI’s claim division of Rhode Island. Outsourced to Perot Systems in 2003Promoted to job after completion of the Health Insurance Portability and Accountability Act (HIPAA) project. • Assigned to the HIPAA project which led to the promotion to the Business Analysis team.

Providence, Rhode Island Area

Led several different teams with training, answering questions and quality control of work. Assigned to negotiate discounts with out-of-state non-participating hospitals. Researched and adjusted restricted employee’s claims. Member of task force to reduce the company’s suspended claims. • Negotiated with out-of-state hospitals for direct reimbursement resulting in reducing the subscriber's out of pocket costs and saving the company over $1M. • Led a team of up to 23 employees by… Show more Led several different teams with training, answering questions and quality control of work. Assigned to negotiate discounts with out-of-state non-participating hospitals. Researched and adjusted restricted employee’s claims. Member of task force to reduce the company’s suspended claims. • Negotiated with out-of-state hospitals for direct reimbursement resulting in reducing the subscriber's out of pocket costs and saving the company over $1M. • Led a team of up to 23 employees by instructing training sessions, answering questions and quality controlling of work. Many of these employees received promotions.• Created a hospital pricing training document to distribute company-wide saving countless hours of adjustments on incorrect manual paid claims. Show less

Providence, Rhode Island Area

Achieved known status as being the “go-to” person for questions regarding benefits and processing of claims. Performed claims entry, adjustments and manual processing of hospital, professional and pharmacy claims. • Identified a participating provider billing error on a subscriber’s submitted receipt that improved the future billing process for future subscribers.