Heather Simpson Jackson Email & Phone Number

Hartford, Ct, Us

Manage 837 Encounter file front-end rejections from Non-Emergent Transportation, Dental, and Vision claims. Vendor Management while providing project coordination corordination on state encounter mandates involving Provider NPI, Taxonomy billing codes ASC X12 guidelines and other mandated requirements. Manage relationships with Vendor to esure compliance and state standards are met by navigation claim rejections implement testing of files to adhere to Elevance service levels. Resolve member 834 beneficiary discrepancies so members can utilze health supplemental benefits.

Coordinate travel and find suitable venues for meetings and events. Project coordination of meeting and event timelines. Schedule and facilitate client meetings to determine the requirements for project plans. Provide technical expertise as a VIP host for webinars and conferences held either in person, or through Zoom, Webex, or MS Teams platforms, by engaging with end-users. Specialize in organizing non-profit, faith-based, and private events.

Direct support to Population Health department providing collaboration for member orchestration through implementation. Create and distribute reporting and provide analytical support for Digital Care Management.Enhance daily interaction for health education opportunities through coordination of member data using platforms such as Salesforce, Avaya Proactive Outreach Manager to send email, text and auto dialer to connect medical members with Medical Management team. Partner with marketing and regulatory to determine appropriate content that needs to be sent based upon state, federal contractual regulations.

Remote

Configuration analyst for New York line of business for claim benefit and product issues. Elicit and gather NY State Medicaid requirements in agile workflow. Design, build, and test configuration so proper adjudication can be applied. Production support of systems issues by performing root cause analysis utilizing SQL qurieris. Align with Health Plan and business partners on systematic deficiencies and provide resolution.

Remote

Configuration Root Cause analyst that reviews FACETS Benefit and Pricing configuration to determine potential errors, trends that are presented by provider appeals or internal associates. Review review back end configuration of what was entered into Facets through SQL queries. Collaborate with business partners for resolution of issues when determining configuration errors are present

Remote

Test systems, procedures and processes to ensure all informational system products within the Claims and Benefits modules meet organizational standards and end-user requirements within claim system. Document all problem resolutions and reports for management in test case generation. Samplings of test cases are created to produce reports or system outputs. Data is analyzed and validated by utilizing SQL and ensuring results are defect free.

Remote

Create Benefit Configuration design for Client based upon requirements for Individual, Small Group and Traditional Benefits requirements. Troubleshoot claim errors and determine root cause while executing system front-end and back-end analysis. Educated client on system applications and how to properly utilize system for projected outcome.

Remote

Government Business Division –Facets Benefit Configuration Analyst that identifies complex business needs related to Medicaid health plan benefits then translates those needs into FACETS benefits configuration requirements. Partner with Health Plan and Claim operations, and Provider network support teams to achieve configuration for specific market. Resolve production claim issues related to configuration. Produce Access query reports and translate data from back end repository that will support configuration builds. Consult and mentor less experienced team members.

Bloomfield, Connecticut

Performs all aspects of FACETS configuration build for production and projects related to Service Payment, HRA Administration Information, HRA Allocation Rules, and Product applications. Build Pega rules to assist in adjudication processing. Researches and resolves reported issues related to Facets configuration Utilize Toad Query Tool for configuration prepare configuration for weekly Migration.

Remote

FACETS Benefit Configuration Analyst responsible for resolving productions configuration issues. Responsible for updating Medical Plan Applications, Application Support some applications impacted are Service Payment (SEPY), Service Procedure (TPCT) Service Revenue (RCCT), Processing Control Agent (PCA) Rules, Service Related Parameters (SERL) Supplemental Proc (SPCT) ,Revenue Conversion (SRCT). Medical Utilization Edits by Service and Procedure (UTSE/UTIP).Create Deductible (DEDE) and Limit (LTLT) rules as well as maintaining the Accumulator Display so that Limits and Deductibles can properly account during claim processing without any claim errors. Consult with business departments to identify benefit requirements. Develop and maintain working relationships at all levels of the business unit. Define project scope and objectives. Work with the business to identify minimum performance expectations and service levels. Validate that all functions perform according to the relevant specifications.

Norwalk, Connecticut

Interface with Health Plan Insurance companies on how to best implement claim rules for editing software, ClaimsXten. Create and modify configuration logic. Utilize claim processing expertise to provide solutions for errors. Work closely with Implementation team members to effectively meet the agreed timelines of projects. Provide Gap analysis on claim practices.

Virginia Beach, Virginia

Develop, train, coach Claims Operations staff on claim errors or when a training deficiency has been identified. Technical communicator of policy and procedure updates. Provide direct on-the-job training, coaching, and one-on-one feedback on performance to new and existing Claim associates. Develop and update additional job aides, handouts, resource documents, and training materials as needed. System Tester for new provider and hospital contracts, existing contracts for upgrade and implementation projects. Participate in Readiness review preparation. Create Test plans, Enter Test Cases and provide Negative / Positive Testing.

Virginia Beach, Virginia, United States

Medicaid Claims supervisor led upto 16 Medical claim processors for the Georgia Medicaid Claims market. Managed daily inventory for bottlenecks impacting timely processing. Connected with external departments such as Eligibility and Configuration to determine root cause of processing issues. Managed one on one staff discussion based upon monthly quality scorecard measurements. Participated in Readiness review with newly migrated state auditors. Wrote process and procedure to provide direct on how to handle special guidelines of configuration or circumstances where requirements are our of scope of claims administration platform. Partnered with Health Plan Serve and served as claims liaison in representation in State Legislative Meetings. Onsite eduction of Provider Relations Representatives and High Profile Providers onsite for claim issues and provide resolution.

Virginia Beach, Virginia, United States

Directly supported Medicaid Claim Supervisor to while provide technical leadership to a team of upto 26 associates. Assist managing daily Facets inventory. Provide assistance to Health Plan Provider Reps on claims issues. Trained new hire associates and provide team training on new policy and procedures as well as ongoing updates to team. Assist with preparation of reporting compliance to the state. Update daily load balance assignment with Supervisor. Participate in meetings where root cause development is identified and resolved.

Virginia Beach, Virginia, United States

Adjudicated Medicaid claims for all medical specialties. Utilize CMS-1500 and UB92 claim form. Provide support to team for different claim issues. Review, create and dispense spreadsheets for analyst review. Review provider contracts for correct payment. Participate in various meetings that relate to claim issues. Utilize State Medicaid and AMERIGROUP policies and procedures to resolve claim related questions.

Portsmouth, Virginia

Manage contracted event logistics including working with internal and external customers and suppliers. Effectively mange bookings work closely with culinary team on specific dietary requests. Event setup and breakdown as well as day coordination of events to ensure event runs smoothly as intended by the customer. Create unique client experiences to enhance events.