Jasmine W. Email & Phone Number

New York, New York, Us

• Lead end-to-end planning and execution of operations functions aimed at streamlining business processes across the healthcare claim adjudication system. • Manage the implementation of health insurance plan data and the creation of regulatory documentation ensuring accuracy and efficiency.• Collaborate closely with product managers and software engineers to identify, define, and prioritize operational requirements for existing and new health plan offerings, contributing to product development and change management initiatives. • Implement new capabilities from the strategic roadmap, driving product and organizational goals and enhancing overall efficiency.• Oversee the review and optimization of operational systems and procedures, resulting in increased throughput, cost savings, and enhanced quality.• Develop and deliver training programs, dashboards, and tools aligned with the operations strategic vision, fostering continuous improvement.• Direct internal and external resources to exceed service level expectations, maintaining consistent professionalism and judgment.• Identify and drive initiatives that help improve Configuration operating model and capabilities with buy-in from cross-functional leaders.• Develop and maintain demand and capacity forecasts, contributing to strategic resource allocation.

Arlington, Va, Us

• Provide leadership and guidance to the system configuration managers who are responsible for overseeing the development of configuration builds, including benefit and payment rules, provider reimbursement and structures, and system parameters that accurately process and pay claims as specified in client contracts.• Direct vision and strategy for Intake and Triage Configuration processes, ticket creation/verification/triage process, ticket automated prioritization process, and identify trends and potential critical issues that impact across line of business• Identify and drive initiatives that help improve Configuration operating model and capabilities with buy-in from global leaders.• Define departmental team vision and strategy within the Intake and Triage team• Provide recommendations on development and design of new system logic to support legislative activity, medical policy changes, and reimbursement methodology changes.• Actively participate in quality assurance activities to promote traceability, accountability and adherence to standards and best practices for configuration in a multi-instance model within production teams.• Enhance system configuration capability in various areas where there is a need for long term business need• Leading department efforts of supporting technology solutions to redesign and enhance components of Configuration system functionality/capability which has led to a 20% increase in claim auto adjudication• Act as department liaison for all companywide technology enhancements, working with various external stakeholders such as Product owners and Domain Tech Leads for solutioning• Create standard operating procedures for the department and develop tactical plans and policies and procedures to improve processes and systems.

Arlington, Va, Us

 Streamline claims management process by spearheading a team of 13 onshore and offshore configuration analysts, ensuring accurate,timely, and cost-effective pricing, benefit, and provider configurations in claim processing systems across Commercial, Medicaid, and Self-Funded lines of business.● Implement risk management best practices by interacting cross-functionally with departmental/interdepartmental team members for final resolution of client projects.● Increase efficiency by decoding and defining new and updated business requirements provided by the client and translating into operational configuration functions and designs, achieving a 98% processing rate of insured claim queuemetrics.● Boost project performance and success rates by creating detailed project plans and delivering against them to meet multiple conflictingdeadlines within a high-pressure environment, improving the claim settlement rate by 6.1% for the entire company.● Improve business processes and efficiency by establishing and documenting policies and procedures to standardize processes withinthe department.● Minimize downtime and increase productivity by initiating new company-wide system applications to help solve issues initially identified, resulting in a 20% increase in client's claim auto adjudication rate.● Monitor and enforce continuous SLA compliance by delivering weekly metric/SLA reporting to communicate to management and key stakeholders of project deliverables, status updates, and issue resolution.● Bolster team efficiency by utilizing Agile processes to ensure quality and timeliness, resulting in a 50% reduction in inventory backlog.● Spearheading department and company wide-system upgrades/releases to drive continuous improvement in software delivery throughout the enterprise, improving efficiencyand end-user experience.● Verify compliance with laws and regulations by formulating and advancing department policies and procedures to streamline internal processes

Arlington, Va, Us

● Maintained data within the core claim processing system within areas of provider, pricing, and benefit rules, to verify claims paid correctlyand on time, eliminating bottlenecks and expediting provider reimbursement.● Verified compliance with established laws by supervising credentialing variables and demographics to ensure safe and effectivehealthcare, reducing the burden on all stakeholders and positively impacting quality.● Ensured seamless transfer of medical records by overseeing dictionary/master file maintenance, including research, set up, andmaintenance of medical codes, allowing health care providers to process bills correctly.● Reviewed and updated client benefit plans for insurance benefits by sustaining group/benefit additions, terms, and changes, to meetconfirmed client requirements, allowing consumers maximum opportunity to purchase health insurance.● Facilitated quality health care delivery by keeping practice fee schedule up-to-date, including terms, affiliations, and contract maintenancewithin internal and external payment systems with different reimbursement methodologies with CMS Medicare Pricing, helpingdetermine the number of fees to the patient, meeting/exceeding financial needs.● Improved member and provider experience by troubleshooting and resolving claims suspended in work queues for configurationintervention in a claims processing system to enhance service efficiency, meeting required SLA’s.

Arlington, Va, Us

● Enhanced representative's calls by offering daily direction and communication to call center agents to add knowledge and ensure callsare handled on time and efficiently, achieving a high level of customer satisfaction.● Boosted agent performance by regularly delivering statistical performance feedback and coaching to each team member, improvingcustomers' experience.● Maintained excellent service levels and call center performance by creating and revising policies, procedures, forms, manuals, andreference materials to advance area operations, efficiency, and service to internal and external customers.● Met customer expectations and provided a better experience by delivering bi-weekly insights from customer service data updates forcall centers through shared presentations, increasing the quality of customer service offered.● Maximized work performance, relationships, and effective communication skills by facilitating coaching, mentoring, and giving customerservice representatives feedback through reports, conducting quality audits, and other tools, improving first call resolution.● Uphold organizational values and enhance team efforts by creating a value-based employee monthly recognition program, increasingemployee engagement and productivity.● Establish and document protocols by creating employee resource job aid for the department to deliver end-to-end solutions, decreasingissues and reducing downtime.● Raise team efficiency and quality standards by establishing a bi-weekly knowledge-sharing program within the customer service department, improving quality assurance by 30%

▪ Deliver high-quality customer service, listening to members and providers’ requests and working to find the appropriate solution.▪ Respond to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.▪ Develop and maintain positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.▪ Review insurance claims after they are submitted to make sure that proper filing procedures have been followed▪ Assist claimants, providers and clients with problems or questions regarding their claims and/or authorization requests.▪ Review and assist providers with authorization

Normal, Il, Us

Facilitates check in process for patient in Emergency Department Accurately identifies patients and their placement on the Emergency Departmenttracker Updates demographic and insurance information for each patient Provides all hospital and insurance information in a friendly manner Acquired Point of Service collections in the Emergency Room at time of dischargefor all self-pay and insured patients. Scanned and analyzed Emergency Department patient records post discharge andpost clinical documentation.

Peoria, Il, Us

Shadowed different positions within the departmentPerformed quality assessments on previous paper recordsFiled and Indexed medical records Reduced the quantity of medical records within storage facility while performing QAAcquired training within EPIC electronic medical record system