Barry Jacobsen Email & Phone Number

Somerville, Nj, Us

Somerville, Nj, Us

New York/New Jersey

Currently seeking new opportunity with implementation or ongoing support related to health insurance medica insurance.

Melville, Ny

Provide varying levels of implementation consulting services through configuration, analysis, validation, and project planning to clients ensuring successful health plan implementations.

Princeton, Nj

Compile data for national database regarding mental health and substance abuse treatment plans offered by behavioral health treatment facilities.

Usa

Interpret summary plan documents to define business rules specific to claim adjudication and benefit plan set up.Configured claim adjudication software to meet new business rule requirements both for claim adjudication and benefit plan set up.Supported client base with expert level analysis of claim adjudication issues and problem resolution.Interfaced with end users to define and implement new system claim adjudication functionality. Analyzed, documented and tested system flaws applying use cases to ensure corrective measures are applied and work as documented.Supported ongoing business issues related to effective use of claim adjudication software.Contractor to the following organizations:Galaxe Solutions, Express Scripts/Medco merger - Somerset NJBeacon Technologies Group, Indianapolis, IndianaMetroPlus Inc.

Union, New Jersey

• Analyzed, configured, tested and documented business and claim adjudication rules for over 50 TriZetto clients.• Experienced problem solving benefit configuration related issues and then making critical independent decisions for corrective action.• Lead business analyst who developed business rules for Facets disability system.• Performed root-cause analysis for client benefit set up issues regarding questionable adjudication outcomes. • Experience gathering and communicating complex benefit configuration requirements in a simple and easy to understand manner to other staff. • Wrote use cases then performed user acceptance testing.• Wrote user guides for end user system documentation.• Proven ability to work in a liaison role between technical and non technical staff to insure business requirements are not only understood but are acted upon.• Comfortable working knowledge with medical codes, ICD9/10, CPT-4, RVU, DRG, etc.

Fairfield, New Jersey

Conducted requirement-gathering sessions, identified software functionality gaps, wrote detailed requirement specifications by analyzing specific business processes and user requirements, as well as recommending and testing specific software configurations and workarounds to meet client objectives for healthcare payer claim adjudication systems.Implemented new claims processing methodologies to enhance, streamline, and increase claim processing accuracy.Developed reporting requirements doer reinsurance company specific requirements related to specific and aggregate stop loss claims.

Newark, New Jersey

Managed all aspects related to new business installation and data conversions for group health plans moving to new claim adjudication system. • Successfully analyzed and defined stakeholder health plan benefit business requirements then configured the software to accurately adjudicate claims for over twenty self funded groups from 50 - 20,000 lives with combined revenue over $1 million dollars.• Designed custom interfaces for banking and enrollment requirements.• Key client contact for on-going support after “live date”.• Led the sales support team by assisting in the sales cycle as subject matter expert (SME) at customer site.• Lead analyst who designed the on line benefit rule configuration to efficiently adjudicate the BCBSNJ Medicare supplemental business, (Horizon's largest line of business by claims volume).• Keen ability to multitask multiple projects at one time.• Heavy interaction with TriZetto regarding system problems and new functionality. .

New York City, New York

Trained users to process claims on claims processing system.Lead Customer Support Representative resolving all claims processing issues related to claim pends, denials and payments. Quality Assurance Analyst testing fixes and enhancements for Claim Adjudication Software system.Process overflow claims for over 20 vendor clients.

New York City, New York

Claim processor for Group Medical claims processor working exclusively in a manual environment. Resolve customer problems and complaints.