Lisa Longfellow Email & Phone Number

Pittsburgh, Pennsylvania

Responsible for recurring Provider data analysis / reports using Microsoft Access and Microsoft Excel. Responsible for the daily interface of provider data to the claim production system including evaluation of error records. Geographical access analysis using the Geo Networks software. Create and maintain departmental process and procedure documentation. Responsible for the thrice weekly provider update to the UPMC website, member facing provider search feature.

Greater Pittsburgh Area

This was initially a six-month contract at Highmark. I was responsible for business requirement gathering and creating a test plan using the Rational Unified Process (RUP). In this role, I had to quickly gain an understanding of the business needs for an Automated Document Factory. All work was contingent on a specified release timeline. Excellent problem solving and time management skills were required. My ability to work independently, learn new technology and prioritize was utilized in this position.

Greater Pittsburgh Area

I was hired under a six-month contract through Sapphire Technologies April 2010. In August 2010, I became a regular full-time PNC employee. I was responsible for creating Professional and Institutional Business Rules in the ILOG BRMS (Business Rule Management) software. These business rules would ensure the customer a smooth submission of electronic, 837 claim files, to national health insurance plans and expedite delivery. The process required understanding the Electronic Data Interchange (EDI) process as it relates to 835 and 837 transaction set of X-12 data. I was responsible for creating test plans, executing the test, and defect reporting. In this role, I would periodically review State and Federal CMS Provider Bulletins for appropriate ILOG BRMS Business rule updates. I created a standardized Business Rule Creation/Update document in the Share Point Site to be used across the enterprise. I created the 270 and 276 Companion Guides in the Edifecs Healthcare IT Solutions application and performed peer review of the guides. I was responsible for a monthly departmental report that included transaction volume and key performance indicators. This report was communicated to the department’s management staff through the Vice President. I passed a Federal Background Check that enabled my security clearance to handle Veteran’s Administration protected health information. I passed a Pennsylvania Child Abuse and History Clearance check in order to volunteer for PNC Grow Up Great. I participated in various discussion groups and the PNC Employee Satisfaction Committee.

Greater Pittsburgh Area

I was promoted multiple times during my career at Coventry Healthcare. In the IDX System, I processed, adjusted and performed high-level quality review of difficult and sensitive Medicare and Commercial claims. This included benefit interpretation, provider contract review, and system data mine via a data warehouse query for possible claim overpayments including Workers Compensation and Third Party Liability/Subrogation. I created employee training documentation, process and procedure documents, and conducted training classes across the enterprise. I mentored fellow team members who continue to be successful members of the organization. As a Senior Lead and Supervisor I was responsible for team assignments, production and supporting the mission of Coventry Healthcare. During my time as a Business Analyst, I was responsible for inventory control and projection, reports for management, system data mine for overpayments, Business Unit testing (including end to end and regression testing). I was responsible for team documentation of process and procedures. I created an inventory calculator using Microsoft Excel to assist with staffing requirements and future projection of business need for personnel. I developed a process to efficiently return fund to providers and members that were sent to the Recovery Operations department in error. This process eliminated manual intervention and allows for the smooth transition of the funds via the internal IDX General Ledger. I participated in a discussion group for 1099-withhold and developed a workflow of the accounts payable process using Visio for this discussion group. I was responsible for gathering information for new plans across multiple states and communicating this information effectively to the Recovery Operations team. This included working with the new health plans to ensure their understanding of the Recovery process as it pertained to the IDX system and how the new workflow would affect their business.