Deborah Fish Email & Phone Number

Durham, Nc

Commercial Group ReportingState Health Plan Reporting

Schenectady, Ny

•Serve as department lead for multi-year project to build an integrated Enterprise Data Warehouse•Participate in workgroup to choose a new BI tool with decision making authority•Provide support and lead discussions for socializing Data Governance and act as data steward for Product and Enrollment•Build capitation calculations to fuel Employer Group Reporting and Accounting Models•Developed Medical Loss Ratio reporting by group size, region, benefit design and employer group•Manage automation of membership reporting and scheduled distribution of corporate membership reports used as the source of official counts for Finance, Actuarial, Sales, budgeting and Regulatory, including data for the Federal HIOS website•coordinated implementation of a premium data warehouse•Coordinate end-to-end Withhold process for multiple IPAs, fee schedules and regions including calculation of withhold and disbursement to providers •Act as a liaison between IT and Actuarial and use technical skills to help business automate solutions •Provide coworker training and mentoring to new staff

Schenectady, Ny

For 18 months, worked in with a special task force, with representation from around the company, to implement a change in claims processing/membership/billing system, going from CSC to Facets; • configured new system including products, enrollment, billing & bills, provider remittances• coordinated the creation of new databases in a warehouse for claims, membership and premium reporting; • created new reporting from the new system for all departments in the company

Schenectady, Ny

• Implemented company move from an in-house RVU to Medicare RBRVS• Performed annual studies of how the new year’s RBRVS would impact contracting physicians• maintained and implemented all physician fee schedules• key contributor in the selection of new claims processing system

Schenectady

• IPA reporting, including attending & presenting at monthly IPA meetings with department Director• Revised the Medical Management Reports, moving the platform from Lotus 123 to Microsoft Excel• Revised the Medical Management Reports data gathering from manual entry based on green-bar reports to downloaded information• Coordinated with our pharmacy vendor to get text files of data instead of hard copy reports

Schenectady, Ny

• Supervised o Claims Customer Service Repso Claims Review Assistantso Fee study analystso Comprehensive Claims Examiners• Co-authored Claims processing manual

Schenectady, Ny

Member calls

Menu Planningfood orderingSupervised kitchen with full-time union and student employees