Desiree Duncan Email & Phone Number

Houston, Tx, Us

Minnesota, United States

Remote

• Led client and leadership facing EDR and enrollment quality improvement programs, improving delivery quality.• Mentored team members to improve requirements elicitation techniques, learn new skills and empowered leadership within the team, developing internal potential.• Coordinated development efforts between internal cross functional development teams, both onshore and offshore, including representing business operations in product backlog maintenance.• Coordinated and collaborated with client cross functional IT and business teams to create technical requirements and architecture for system integration projects with payment integrity systems, Optum grouper/pricers, and internal Xcelys claims adjudication system pricing functionality, improving pricing accuracy of the core claims adjudication system• Developed technical requirements, Visio workflow diagrams, use cases and documentation, improving understanding of the technical design for both business and technical project resources.• Extensive development and QA support through the product delivery lifecycle and beyond, including training both onshore and offshore developers to support the product, and aiding in production questions/issue resolution.• Monitored CMS regulatory requirements and performed impact analysis of core and client code branches maintaining compliance for Medicare, Medicaid and Healthcare Exchange implementations. Responsible for technical requirements, as well as guiding other analysts for larger regulatory initiatives.• Learned, set up and configured Jira and Confluence for an internal demo of Agile methodologies.

Tampa, Florida, United States

• Served as Sr. Project Manager for PDP Operations business group to facilitate Prescription Drug Plan product initiatives and integration with a third-party administrator for a Private Fee for Service product line.• Represented the WellCare IT department at CMS conferences, filling both a lead business analyst role and project management responsibilities for IT planning and eventual implementation of Medicare Part D, collaborating with business operations and external PBM and claims system vendors leading to a year one membership of 1 million.• Reversed engineered internal surround code and reviewed front end claims processing procedures to document business rules for process improvement.• Analyzed data using PLSQL to identify and resolve issues with member premium billing, escalating to the claims adjudication system vendor to resolve issues in the core platform.

Bannockburn, Il

Built new business operations department to support the Pharmacy Benefit Management (PBM) claims adjudication software, resulting in improved issue triage and resolution of tickets that did not require development resources. • Facilitated interactions with business operations cross functional teams for escalated issues and bug resolution improving prioritization and resolution of coding issues.• Analyzed data and monitored regulatory changes to prescription drug data reported on behalf of WHI clients.• Actively participated in quarterly NCPDP workgroup meetings, the standards organization responsible for defining pharmacy data transactions, raising questions to CMS representatives about regulatory guidance and data reporting.