Barb Mcdonald Email & Phone Number

United States

Eagan, Minnesota, United States

• Supported transitions of business from CCStpa to both BCBSMN (parent company) and to AmeriHealth Administrators (as the result of a sale). Responsible for implementations and testing of client set-ups related to these.
• System platform conversions for the two companies: assisted in migration of existing benefits, claims and accumulator testing, and benefit coding validations
• Supported AmeriHealth Administrators (AHA) and BCBSMN on claims issues, reconciliation of reports and EOB requests during period of extensive change
• Managed Client Center website set-up and termination requests for clients and internal employees; helped resolve claims and membership inquiries throughout transitions
• Tested and validated new business runout tools (claims, membership, and provider) in preparation for BCBSMN’s decommissioning of existing systems
• Collaborated with external vendors and internal staff to implement multiple projects, including Workday HCM software

Eagan, Minnesota, United States

• Implementation and testing of self-insured clients’ strategic initiatives for business requirements and network arrangements
• Risk mitigation; identify solutions to complex issues and communicate outcomes or potential outcomes with stakeholders
• Benefit validation for new and existing clients; Validation of accumulator and eligibility files for new and existing clients
• Managed team mailboxes for R&Q, Claims, and Customer Service areas (researched and responded to various types of inquiries from external and internal sources)

Eagan, Minnesota, United States

• Built and maintained client set up information and medical/vision/dental benefits within online tools for new and existing clients
• Created and submitted prescription benefits, provided account structure/mapping for eligibility feeds to external pharmacy vendors (e.g., Prime Therapeutics, Express Scripts)
• Reviewed/audited new and amended benefit plan designs for Summary Plan Documents
• Created and maintained member ID cards, provided ID card mapping for eligibility feeds to external printing vendor
• Supported RFP process for benefit capabilities review to identify manual processes
• Participated in cross functional new client implementation and renewal meetings, working with Sales Operations, Account Managers, Underwriters, Contract Writers, Brokers, and Vendors

Eagan, Minnesota, United States

• Collaborated with Account Management and clients/agents to clarify medical, dental, vision, and prescription benefits, and obtain written documentation and approvals
• Researched multiple reference materials and systems to analyze and code benefits and to resolve claims processing inquiries
• Conducted system testing of benefit coding to ensure accuracy
• Created Benefit Summary Sheets for Claims and Customer Service
• Reviewed/audited new and amended benefit plan designs for Summary Plan Documents
• Assisted in the training and auditing of Benefit Analysts

Eagan, Minnesota, United States

• Trained new and existing employees on area specific skills, procedures, and system components required to perform their job functions for claims and customer service
• Audited claims processed by trainees
• Developed and maintained system/user documentation and manuals
• Observed and coached employees one-on-one in a classroom setting or on the floor in response to specific questions or individual developmental needs
• Assumed mentor and role model responsibilities

Eagan, Minnesota, United States

• Processed medical, dental, and prescription claims on two different system platforms
• Reviewed and released high dollar claims
• Resolved complex system edits and requested necessary documentation in order to finalize claims
• Mentored and provided training to other claims examiners