Diana St Clair Email and Phone Number
Diana St Clair work email
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Diana St Clair personal email
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Hello! I have over 18 years of experience in both the Managed Care and Commercial Health Care industries. In addition to subject matter expertise in Provider Data, I have experience in training and coaching, technical writing, Data Migration life cycle, and Quality Control.Professional Goal: To provide quality organizational, training, and auditing expertise in the health care industry.Skills and Abilities: • 18 years of experience in Medicaid and commercial health care• Strong customer service and professional interpersonal skills • Data analysis and report production, maintenance, and distribution • Microsoft Access & Excel, Quest Analytics Suite, SQL/SAS, Business Objects, Portico, Amisys, Salesforce, MicroStrategy, technical writing, internet research, medical claims repricing and analysis• Proofing and auditing, training, coaching, working with sensitive and confidential materials • Manual software testing and data migration experience • Quality driven, customer focused, self-motivated, and extremely flexible
Highmark Health
View- Website:
- highmarkhealth.org
- Employees:
- 15286
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Senior Reporting Analyst - Claims And Financial AnalyticsHighmark HealthWesterville, Oh, Us
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Senior Reporting Analyst - Claims & Financial AnalyticsHighmark Health Nov 2019 - Present• Network Adequacy analysis development and production for Medicaid lines of business• Report development and production for State Medicaid deliverables• Claims, member, and provider reporting and analysis• Audit, process improvement, business solutions, and provider data consulting
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Senior Reporting Analyst - Adequacy Analytics/Decision SupportGateway Health Jul 2018 - Oct 2019• Network Adequacy analysis development and production for Medicaid and Medicare lines of business; creation of Network Adequacy desktop procedures• Prepare State and Federal submission documents• Claims reporting and analysis• Provide support and subject matter expertise to internal customers -
Senior Business Analyst - Network DevelopmentGateway Health Apr 2017 - Jun 2018• Provided analytical support for existing lines of business and expansion efforts• Developed and maintained New Market contract intake data for State submissions, internal reporting, and Network Adequacy analysis• Provider and Ancillary prospect/mailing list creation and tracking for development and expansion• Assisted in RFP preparation in multiple markets
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Business/Data Analyst - Health Economics/Data-AnalyticsBuckeye Community Health Plan, Inc. Dec 2014 - Mar 2017-Provided and developed reporting and analytical support for Provider Data, Finance, Network Management/Contracting, and Enrollment departments-Managed State Medicaid deliverable reporting and projects-Manual FFS (Medicaid) analysis-Interactive modelling for cost saving efforts -Provider, member, and claims analytics-Report distribution and maintenance to vendors, external customers, and internal leadership -
Lead Provider Data Coordinator/Senior Data Integrity Specialist - Provider Data And AnalyticsBuckeye Community Health Plan Feb 2012 - Nov 2014Remote From California- Created departmental SOPs and P&Ps- Managed complex data system load preparation for data migration and system upgrades- Managed and trained temporary staff to assist with Data Migration- Provided continued coaching, training, and education for Provider Maintenance staff- Production and distribution of provider turnaround metrics and ad-hoc reporting- Work closely with System Configuration Team to ensure proper claims payment- Electronic Physician and Facility submissions to the State- Absorbed other duties from my previous position as Quality Control Coordinator
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Quality Control CoordinatorBuckeye Community Health Plan Jan 2009 - Feb 2012Columbus, Ohio Area- Designed and implemented end-to-end audit processes for Provider Maintenance Department- Created audit tools, report templates, and Policies and Procedures- Made recommendations for process improvement and continued training and education for staff- Identified the need for and initiated claims projects and data cleanup projects- Monitored and ensured quality compliance for ODJFS Medicaid Regulations, ODJFS Network standards, and monthly Encounter Rejection reports- Served as Provider Maintenance Subject Matter Expert utilized to assist team staff with coaching and training- Participated in onsite internal audits and external regulatory audits. Creation, execution, and monitoring of quality and process improvement plans
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Provider Maintenance AdministratorBuckeye Community Health Plan Feb 2007 - Jan 2009Columbus, Ohio Area- Administered provider adds, updates, system audits, and provider terminations under multiple programs for delegate and directly credentialed providers- Compiled complex databases for system upgrades at ODJFS- Gathered information for data migration- Electronic data submission to ODJFS to maintain Network standards- Compiled data for print and web based provider directories
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Credentialing SpecialistUnitedhealthcare Aug 2002 - Feb 2007Columbus, Ohio Area- Daily and bi-weekly production of Credentialing Committee packets by compiling extensive practitioner based information- Knowledge of health plan specific requirements, NCQA standards, creation and maintenance of templates for production purposes, and utilization of company software to generate, format, and distribute reports- Performed demographic updates and verification of practitioner based information and conduct proofing and auditing on a regular basis- Demonstrated a high and consistent accuracy rate and displayed the ability to work under pressure and meet critical deadlines- Proficient in UnitedHealth Group’s PMW, EPD and NDB software as well as Customer Service training for the National Credentialing Call Center
Diana St Clair Skills
Frequently Asked Questions about Diana St Clair
What company does Diana St Clair work for?
Diana St Clair works for Highmark Health
What is Diana St Clair's role at the current company?
Diana St Clair's current role is Senior Reporting Analyst - Claims and Financial Analytics.
What is Diana St Clair's email address?
Diana St Clair's email address is di****@****ail.com
What skills is Diana St Clair known for?
Diana St Clair has skills like Managed Care, Medicaid, Hospitals, Process Improvement, Healthcare Information Technology, Healthcare Information Technology, Business Process Improvement, Medicare.
Who are Diana St Clair's colleagues?
Diana St Clair's colleagues are Lorraine Deiter, Susan Hurrell, Kimberly Majkozak, Csm, Aimee Girod, Cheryl Gilvary, Lisa Magnotti, Lindsay Dalby.
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