Evonne Darr, Pmp, Cbap Email & Phone Number

• 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.
• 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.
• 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.

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.

• 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.

• 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.

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.

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.
• 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.