Evonne Darr, Pmp, Cbap Email & Phone Number

Greencastle, In, Us

• Apply project management knowledge, skills, tools and techniques to project deliverables, processes, and systems. • Determining project scope; develop resources, risks, quality, cost, and scope management plans; develop training plans; develop requirements documents, process flows, stakeholder matrix.• Identify project team training and tool needs; define, manage transaction services agreements; coordinate requirements, schedule integration and post-integration plans, and develop service-level agreements for vendor partners and global resources firms. • Define and execute quality gates for each project methodology phase; assist in leading Discovery and Target Operating Model as appropriate, define and track critical success factors, synergies, and KPI’s; and establish and manage the project warranty period.• Apply Project Management and PMO best principles, skills, tools, and techniques to meet project deliverables and delivery quality products to customers and partner organizations.

Phoenix, Arizona, United States

• Facilitated full project life cycle including requirements gathering, project plans, schedules, resource management, execution, deployment, and closure for healthcare payor/Third Part Administration.• Facilitated agile sprint planning, performing requirements analysis & process development. • Collaborated with internal and external teams to develop system design solutions.• Ensure compliance with regulatory requirements and industry standards throughout integration. • Conducted root-cause analysis of data irregularities, presenting findings and solutions to leadership and clients.• Utilized MS SQL Server for data extraction, data analysis and report creation. • Supported Operations by providing trending and performance data for business decisions.• Supported building rules to deliver first-pass auto-adjudication, macro processing rules & claim edits.• Created and executed test plans to ensure that implemented solutions met requirements.• A liaison between business stakeholders and the technical team. Facilitating communication to ensure requirements are clearly understood and met.• Assisted with the setup, review, and auditing of EDI Transaction Sets.• Developed documentation encompassing workflows, detailed process flows, and quality metrics.• Identified reporting needs, documented requirements, and testing of new reports.• Analyzed and translated business needs into detailed functional and technical specifications.• Conduct post-integration evaluations to identify areas of improvement & ensure continuous optimization

Tucson, Arizona, United States

• Conceptualized, founded, and successfully launched a pet sitting business.• Assessed all aspects of business operations to implement an annual budget.• Executed integrated advertising campaigns across multiple media channels.• Created, implemented, and maintained the company website.• Attained 250+ new customers and referrals in one year.• Offered exceptional customer service to differentiate and promote the company brand.

Connecticut, United States

• Managed the integration of 1.4 million members to a new CMS contract and processing system.• Facilitated requirement gathering sessions, resolving conflicting requirements & clear documentation.• Utilized MS Project Management software for project plans, resource management, and tracking.• Ensured project deliverables adhered to quality standards including design documents, test plans, training materials, and operations documentation.• Evaluated system requirements for new processes addressing business models for pharmacy products mandated by regulatory agencies.• Facilitated effective communication and collaboration among stakeholders and cross-functional areas.• Served as point of contact for fulfillment, working closely with the Service Team, Operation Lead, and Compliance.• Facilitated process improvements, leveraging new system capabilities.• Conducted Annual Open Enrollment (AEP) execution, produced user documentation, training materials, and membership communications.• Collaborated with Medicare Product Managers for compliance and beneficiary impact assessments.• Integrated finance and billing systems with operational workflows.

• Led efforts on EDI mapping to improve accepted submissions of healthcare data.• Facilitated root cause analysis and escalation of operational issues.• Reviewed provider network, fee schedules, and contract configurations for accuracy.• Led business requirement sessions and updated requirements for compliance projects.• Established relationships with claim teams, matrix partners, and vendors to meet requirements and KPIs.• Coordinated audits to identify and provide results for operational improvement.• Connected business operations with analytics to influence business strategies and solutions.• Developed and maintained proprietary codes compliant with Uniform use of CAGC, CARCs, and RARCs rules.

• Acted as liaison between IT engineers and end-users.• Trained customers and evaluated business systems and user needs.• Ensured compliance with CMS MA, MAPD, and PDP enrollment and disenrollment guidelines.• Developed solutions for service-related issues.• Performed detailed analysis and recommended potential business solutions.• Coordinated with internal teams and eternal partners to ensure successful integration of system upgrades and processes. • Elicited requirements for developing or modifying computer programs.• Collaborated with IT engineers on CMS Medicare mandated correspondence.

Connecticut, United States

• Monitored CMS reconciliation functions for MA PFFS plan Risk Adjustment data.• Implemented and maintained CMS regulations for Medicare Advantage and Part D programs.• Oversaw Risk Adjustment Coder Specialists' procedures and compliance.• Initiated claim service improvements through problem-solving and root cause analysis.• Ensured claim platforms were configured for provider contracts, demographics, fee schedules, and coding structures.• Worked closely with technical team to prepare EDI 837I & 837P transactions for HIPAA version 5010.• Conducted production audits, project testing, and issue resolution analysis.• Answered questions and resolved issues including escalated issues for internal and external clients timely and accurately.

Phoenix, Arizona, United States

• Planned, supervised, and coordinated the activities of Claims Examiners, Auditors, and Adjustors on the claims processing system (Q/Care), ensuring adherence to Medicare Advantage regulations and processing policies and procedures. • Coached and supervised data entry operators on the proper use of CMS1500 and UB04 forms and system entry applications. • Provided ongoing education and training on claims processing system updates, as well as changes to policies and procedures.• Conducted detailed compliance audits on processed professional and facility claims to ensure accuracy and regulatory compliance.• Assisted with the mapping of 837P & 837I Electronic Data Interchange (EDI) healthcare claims, ensuring proper configuration and integration. • Monitored and maintained daily production of staff, consistently achieving and exceeding daily production and quality goals. • Generated monthly reports on AHCCCS (Arizona State Medicaid) encounter claims, analyzing data for accuracy and compliance.• Supported the vendor claim platform, ensuring appropriate configuration of contracts, provider information, fee schedules, and coding structures.• Established procedures and quality standards to maintain high levels of accuracy and efficiency.