Grace Xiao Yu Email & Phone Number

Serve as the Lead Quality Assurance Analyst in the execution of technical data processing of insurance and specialty claims; compile and validate data integrity to maintain compliance with SQL Server database standards. Oversee and quality assure the implementation of content into database tables. Work directly with clients and third-party vendors to understand their needs, desires, and business and systems requirements. Develop and maintain customized SQL stored procedures designed to update data for plans, networks, claims, providers, facilities, groups, and members. Utilize automated scripts to generate daily and weekly reports for management review. Resolve errors of database scripts in MS SQL Server. Update table definitions and stored procedures on the application database. Support providers’ database updates for Operations, Claims, and Financial Service departments. Update members’ addresses and demographic information using SQL scripts in UNIX. » Assist in analyzing and querying multiple, complex databases and systems to produce data sets for external review and analysis.» Developed improved and highly efficient data collection stored procedures using SQL Server.» Significantly collaborate in recognizing, investigating, and resolving data discrepancies and anomalies.» Compile and validate data integrity to maintain compliance with SQL Server database standards.» Assist software developers in their understanding of data structures of new dental plans for development of new application modules in Data Dental software.» Resolved data errors in Billing, Claims, Accounting, Provider Relations, and Operations departments lending to optimized ability to issue billing and premium invoices. » Significantly reduce billing errors through improved scrips and proactive identification of potential and present errors. » Build and develop stored procedures, eligibility requirements, file formats, and file maps.» Perform scripts testing, spanning Unix and SQL.

Alexandria, Va

Identified and analyzed system and claim-related processing errors and controlled the risk of claim errors in support of Claim and Member Services Departments. Tested software on special plan requests and new functions launched in Data Dental. Served as a Subject Matter Expert for new client-requested plan builds. Drafted and revised plan setup documentation for internal and external stakeholders. Configured HMO and PPO dental plans in proprietary adjudication systems, to include the developing methods for administering non-standard product designs. Maintained hundreds of customized pricing schedules. » Executed auditing and accuracy of 100’s of new plan set ups.» Consistently recognized as a top performer in claims processing – for both volume and accuracy. » Assisted software developers in their understanding of data structures for new application modules.» Processed unique and out-of-country claims for the organization. » Completed Monthly Attus Compliance Monitoring Scans for the company; thoroughly analyzed results, and upheld all compliance requirements. » Awarded “Rookie of the Year” in 2012, and was recognized as a candidate for “Employee of the Year” in 2013.