Janet Kruppner Email & Phone Number

Scotts Valley, California, United States

Manages the configuration, maintenance, and input of provider data for claims adjudication, member linkage, and physician reimbursement and reporting activitiesManages and leads the Provider Data Management Unit, acts as a subject matter expert, and provides guidance on unit functions and departmental operationsManages the Provider Data Repository including integrations with other core systems throughout the organizationManages and oversees Provider Portal functions, including customer service deliveryManages, supervises, mentors and trains assigned staff

Scotts Valley, California, United States

Leads and performs initial and complex configuration, maintenance and input of provider data for claims adjudication, member linkage and physician reimbursement and reportingActs as a subject matter expert and lead to subordinate analystsResearches, analyzes and resolves complex issues escalated by internal and external stakeholdersLeads cross-divisional projects and collaborates with internal and external stakeholdersLeads, coordinates and assists with the design of process improvements and monitoring of data quality

Scotts Valley, California, United States

Performs initial and complex configuration, maintenance and input of provider data for claims adjudication, member linkage and physician reimbursement and reportingResearches, analyzes and resolves complex issues escalated by internal and external stakeholdersCollaborates with internal and external stakeholders and assists with the training of other Provider Data Configuration AnalystsLeads and assists with the design of process improvements and monitoring of data quality

Scotts Valley, California, United States

Supporting strategic projects using Provider Data knowledge and expertise Performs analysis of Alliance system, data and reporting needs for projects in The Provider Services area of the Health PlanPerforms maintenance, configuration, development and support of Alliance system and reporting tools for low to high complexity projectsDevelops and performs regular Provider Data auditsPerforms Project Management tasks

Scotts Valley, California, United States

Leads, supports and/or represents the department in provider reimbursement, incentive and system related projects;Conducts research and analysis to resolve complex reimbursement, incentive and system related provider inquiries

Scotts Valley, California, United States

Assists with the design of process improvements and monitoring of data quality, with duties including but not limited to:· Analyzing, researching and resolving system generated errors · Leading gathering, analyzing and documenting user and business requirements and definitions · Assisting with the design of testing protocol · Performing audit processes to ensure work is accurately implemented and meets business requirements · Assisting with system feasibility studies, producing evaluations, and making recommendations based on user requirements and system analysis

Scotts Valley, California, United States

Performs Project Management tasks, with duties including but not limited to:· Managing day-to-day operational aspects of the assigned project and scope· Ensuring project documents are complete, current, and retained appropriately· Communicating project implementation, updates and changes to all effected departments / stakeholders· Attending or leading departmental and inter-departmental meetings (as required) to coordinate quality and efficiency of data, reporting and system needsPerforms maintenance, configuration, development and support of Alliance systems and reporting tools, with duties including but not limited to:· Performing system configuration and maintenance;· Adhering to quality control standards to ensure that audited work satisfies the business requirements defined in the analysis phase of the project and is accurately implemented· Designing new configurations (or modification of existing configurations) to resolve system and reporting errors· Analyzing, researching and resolving system errors· Supporting end users for areas of system and reporting responsibility· Providing training/cross-training of Analytics Department staff as it pertains to areas of responsibility· Developing and maintaining standard definitions, formulas, etc.· Extracting data through the use of reporting tools such as SQL, and other reporting software using standardized data definitions and formulas

Scotts Valley, California, United States

Manages Low to Medium - High complexity projects, performs maintenance, configuration, development and support of Alliance system and reporting tools, with duties including but not limited to:· Designing new configurations (or modifying existing configurations) to resolve system and reporting errors· Managing complex Alliance departmental processes, workflow, data needs, procedures and related documentation [e.g. EDS Provider Manuals, Operating Instruction Letters (OILS), Department Manuals, etc.] and making recommendations for improvement; · Establishing, maintaining and performing efficient workflows for system, data and reporting tasks and providing clear documentation for these processes

Scotts Valley, California, United States

Performs Low to Medium complexity projects, maintenance, configuration, development and support of Alliance system and reporting tools, with duties including but not limited to:· Researching, identifying, and implementing procedure code system updates· Designing new configurations (or modifying existing configurations) to resolve system and reporting errors· Developing and maintaining standard definitions, formulas, etc.· Extracting data through the use of reporting tools such as SQL, basic Data Warehouse techniques and Ad Hoc reporting software using standardized data definitions and formulas

Scotts Valley, California, United States

Responsible for researching, resolving and responding to provider and Alliance staff inquiries on claims issuesProcessing various claim types and conducting research and analysis projects related to claims resolutionMaintaining current knowledge of claims processes, procedures and related documentation [e.g., Medi-Cal Provider Manuals, Operating Instruction Letters (OILs), Claims Department Manual, etc)Assisting in identifying, establishing and maintaining internal operating procedures, and, recommending coding and reimbursement changes in the Alliance’s claims processing program Maintains phone log and Weekly Pre Check Run Reports

Scotts Valley, California, United States

Processing of Medi-Cal insurance claims Specialized in Outpatient, Pharmacy and DME Claim Types

Uc Davis Leadership Online Short Course

Insurance Coding Specialist Certificate

Associate Of Science - As, General Science