Contracted via Medasource July - October 2021; FTE eff. 10/17/21.Enhance the automation of claims adjudication.

• Reviewed & updated provider data in Facets for the launch of Medicaid & Medicare LOBs for a nationwide healthcare provider.

• Reviewed & updated provider data for a nationwide healthcare provider.

• Created & documented processes related to launch of automated pricing tools for Blue Cross Blue Shield of Michigan.• Compiled job aids & reference materials for Provider Contracting Operations Process Improvement (PCOPI) training modules.• Identified & fixed gaps in documentation for PCOPI.

• Responsible for audits, analysis, & maintenance of BCBSM & BCN provider networks including new lines of business developed in accordance with the Affordable Care Act. • Subject matter expert for Plan’s narrow networks, including GM ConnectedCare. • Identified solutions to non-standard requests & issues. • Maintained working relationships with departments across the enterprise. • Represented Provider Operations & Innovation (“POI”) on large multi-departmental projects. •… Show more • Responsible for audits, analysis, & maintenance of BCBSM & BCN provider networks including new lines of business developed in accordance with the Affordable Care Act. • Subject matter expert for Plan’s narrow networks, including GM ConnectedCare. • Identified solutions to non-standard requests & issues. • Maintained working relationships with departments across the enterprise. • Represented Provider Operations & Innovation (“POI”) on large multi-departmental projects. • Maintained provider data in Portico & Facets. • Prepared & distributed ad hoc & standard internal reports. • Created & maintained documentation, policies & procedures, & job aids. • Processed MACESS workflows. • Analyzed pricing data to create automated SuperTable rules. • Performed user-acceptance & regression testing. • Managed Data Integrity Audit Database for POI. • Miscellaneous special projects. Show less

Full time employee effective January 2014.Contracted through Epitec, Inc. September 2013 - January 2014.Position details mirror Senior Analyst - Provider Operations & Innovation (see above).• Served as liaison between BCN Provider Contracting Operations & Amerihealth Caritas for Medicaid line of business. • Loaded & updated Medicaid providers in Portico. Verify interface with Facets. • Utilized Access databases to process workflows & research provider data issues. •… Show more Full time employee effective January 2014.Contracted through Epitec, Inc. September 2013 - January 2014.Position details mirror Senior Analyst - Provider Operations & Innovation (see above).• Served as liaison between BCN Provider Contracting Operations & Amerihealth Caritas for Medicaid line of business. • Loaded & updated Medicaid providers in Portico. Verify interface with Facets. • Utilized Access databases to process workflows & research provider data issues. • Created Medicaid contracts upon request. • Tracked & reported interface issues. • Maintained internal HIPDB request spreadsheet. • Miscellaneous research & loading projects. Show less

• Subject matter expert for Plan’s Provider Data department. • Identified solutions to non-standard requests & issues. • Maintained working relationship with Credentialing, Quality, & Provider Advocacy departments. • Created contracts in response to provider-submitted RFPs.• Load new provider contracts into Access & Facets databases. • Created and modified queries, forms, tables, and reports in Access in accordance with Plan needs.• Updated existing provider records… Show more • Subject matter expert for Plan’s Provider Data department. • Identified solutions to non-standard requests & issues. • Maintained working relationship with Credentialing, Quality, & Provider Advocacy departments. • Created contracts in response to provider-submitted RFPs.• Load new provider contracts into Access & Facets databases. • Created and modified queries, forms, tables, and reports in Access in accordance with Plan needs.• Updated existing provider records. • Terminated providers from network. • Requested member moves. • Made new providers effective after credentialing completed. • Prepared 4275 file for submission to State of Michigan. • Prepared and distributed monthly internal reports. • Created documentation and job aids. • Maintained MACESS workflows, including proper filing of provider records. • Utilized batch scanner and vertexing software to file contracts electronically. • Prepared provider welcome letters for mailing. • Ensured NCQA, State, & Federal requirements were met. Show less

Formerly UnitedHealthcare Great Lakes Health Plan.Member of L.E.E.T. (Local Employee Engagement Team) - 2011.Position details mirror Provider Installation Administrator (see above).

Formerly AmeriChoice• Supported Medicaid, Medicare, and CHIP health plan operations teams in twelve states and Washington, D.C. (Central & Southeast Regions)• Consolidated and prepared operational reports for executive teams. • Led conference calls, tracked attendance, prepared and distributed minutes and follow-up items. • Created, edited, and proofread presentations and proposals. • Provided administrative support for Great Lakes Health Plan (now UnitedHealthcare… Show more Formerly AmeriChoice• Supported Medicaid, Medicare, and CHIP health plan operations teams in twelve states and Washington, D.C. (Central & Southeast Regions)• Consolidated and prepared operational reports for executive teams. • Led conference calls, tracked attendance, prepared and distributed minutes and follow-up items. • Created, edited, and proofread presentations and proposals. • Provided administrative support for Great Lakes Health Plan (now UnitedHealthcare Community Plan) as time permitted. • Miscellaneous special projects. Show less

• Prepared Medicaid and Medicare cost reports for Michigan long-term care facilities. • Made journal entries as requested by client. • Organized work papers to in accordance to firm and national standards.• Assisted with miscellaneous consulting projects per client request.

• Supported three partners and 15 staff members. • Served as backup support for three other partners and 15 staff members. • Created, modified, and processed correspondence. • Coordinated meeting schedules. • Managed client database. • Sent client satisfaction surveys and tabulated results. • Created, edited, and proofread presentations and proposals. • Maintained physical and electronic filing systems. • Organized and planned group extra-curricular events… Show more • Supported three partners and 15 staff members. • Served as backup support for three other partners and 15 staff members. • Created, modified, and processed correspondence. • Coordinated meeting schedules. • Managed client database. • Sent client satisfaction surveys and tabulated results. • Created, edited, and proofread presentations and proposals. • Maintained physical and electronic filing systems. • Organized and planned group extra-curricular events, including Christmas party and summer picnic. • Completed miscellaneous research projects. • Created and processed invoices for all clients of group using Practice Management system. • Supported Employee Benefit Plan (“EBP”) Audit Industry Group. Served as intermediary between Marketing Department and EBP Leader. • Coordinated mass mailings with Marketing. • Served as point of contact for industry group members. • Arranged travel and lodging. Show less

Statewide coordinator for Michigan College Goal Sunday program (20 locations). Duties included grant reporting, creating/tabulating surveys, securing facilities, and managing volunteers.Also served as copy editor for state- and nation- wide publication, EduGuide.