Bryant Wright Email & Phone Number

Atlanta, Ga, Us

Bangalore, Karnataka, In

Cambridge, Ma, Us

-insurance claims systems implementation, managed care/health plans, and new product/benefits plan implementation in an operations capacity. - Handle health Plan industry such as, claims processing, benefits configuration, member enrollment, correspondence, experience in business consulting/product implementation/business analysis. - Responsible for delivering professional services business consulting, client facing, billable projects through solution crafting, vision building, architectural guidance/design, product demonstration, training, educating customers on best practices and optimal use of our products to improve efficiency and satisfy client’s defined business requirements.- Gathering and defining requirements, analysis, configuration, unit testing, and customer engagement. - used healthcare payor rules platform, works closely with stakeholders (i.e. business unit personnel, business experts, other staff, vendors, and contractors) to help them understand and document project business and system requirements. -Responsible for proactively conducting interviews with all stakeholders to elicit detailed functional and system requirements managing the requirements throughout the course of the project. -Responsible for ensuring unique customer needs are properly translated into business terms and communicated across all applicable domains.

Us

• Maximize savings through expansion of new or existing programs across lines of business, platforms, and operational programs• Accountable for monitoring savings and identifying opportunities. Monitor technical issues and drive to resolution in conjunction with matrix partners• Monitors project progress by tracking activity, resolving problems, publishing progress reports and recommending actions.• Prepares technical reports by collecting, analyzing, and summarizing data and trends.• Reviews facility claim data to identify reimbursement rates and trends

•Perform development activities from gathering requirements and designing solutions, through developing code / reports, to testing and release / deployment. •Develop and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies. •Create and publish periodic reports, as well as ad hoc reports. Taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that translates business requirements into usable decision support tools. •Serve as a primary point of contact for Production Support issue resolution

Atlanta, Ga, Us

•Experience gathering and converting data into written narratives that is used for updating benefit implementation project stakeholders and to make recommendations on benefit configuration system changes needed.•Hands-on experience with rules based table driven claims and eligibility administration systems claims processing systems).•Proficiency in medical terminology, medical coding (CPT Codes, ICD9/10, and HCPCS), provider contract concepts and common claims processing/resolution practices.•Analyze explanation of coverage documents to assist with determining best approach for loading benefits offered including member cost share and out-of-pocket maximums.•Identify ways to enhance performance management and operational reports related to new business implementation processes.•Aid in the creation of test scripts, including regression testing cases, to validate system configuration against source documentation.•In-depth knowledge of business processes in IT industries. A thorough understanding of the Software Development Life cycle (SDLC) including various concepts such as Requirement Gathering, Experience in the development of Client-Server.•Proficient in developing efficient business relationships with various client teams in order to process and support requirements, develop tactical and strategic plans to implement technology solutions, and effectively manage client expectations.•Used ClaimsXten to help manage medical policies across all lines of business for NASCO commercial and Medicare programs for both professional and facility claims processing.•Functional knowledge of various modules of insurance like channel management, policy servicing, claims management, underwriting, reinsurance and finance.•Experienced in insurance claims systems implementation previous managed care/health plan experience in an operations department and in implementing new products or benefits into plan systems.

Detroit, Michigan, Us

•Conducted an application conversion and implementation from FEP Mainframe to NASCO web based claims processing system•Experienced knowledge of medical terminology and claims coding including ICD-9/ICD-10, CPT, Revenue and HCPCS codes, CM1500 forms and UB92 forms•Post and reconcile insurance and patient payments. Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts• Insure accuracy of insurance claims. Verify correct ICD-9 and CPT codes for a variety of specialties•Processed patient's billing, statements, reimbursement claims, post transaction and data•Provided general business analysis to supply responses to customers and provider inquires received via telephone, correspondence or in person; involving a variety of complex claim/benefit issues related to various product lines.•Partnered with various workgroups in an effort to improve organizational work flow and improve deliverables and develop new quality standard for turn-around time •Interfaced with diverse levels of internal and external personnel to develop and maintain team cohesion to resolve issues and inquiries •Handled over 100 National corporate accounts with a variety of product lines (CMM, EPO, PPO, HMO, CDH, POS and Medicare)•Train new hires on the general knowledge of insurance claims processing systems; thorough knowledge of the techniques, procedures and claims processing methods

Master Of Business Administration (Mba), Strategic Management

Bachelor Of Business Administration (Bba), Business Administration And Management, General