Mandy Dalton Email & Phone Number

Portland, Or, Us

Portland, Or, Us

Responsible for managing activities of the Payment Integrity Support Services Team including planning, problem-solving, staff development, and communication. Responsible for leading the team with new and existing business processes to identify areas of opportunity and execute business unit objectives, supporting continuous improvement, assisting with the development and implementation of data quality and decision support systems/tools. Manage healthcare claims data research, Vendor Performance and Program Management, Invoicing and Billing, and Payment Integrity market research (policy, benchmarking, vendor capabilities, etc.). Identify strategies to align and effectively support operational data and metrics with changing business needs.

Portland, Or, Us

Support, maintenance, and enhancement of existing systems, as well as the development, configuration, and delivery of new systems. Applies data analysis to provide solutions to increase efficiency and effectiveness of work processes. Works and consults with various stakeholders to define business requirements, understand application data requirements, configure and test applications and system functionality.

Portland, Or, Us

Review provider contracts, provide analysis and recommendation of implementation of Reimbursement Methodologies. Assist Reimbursement Analysts with day to day activities to ensure pricing system are current and accurate. Work closely with Business Support, Network Management, and Provider Enrollment to ensure negotiated payments with providers are implemented accurately and promptly. Research and address any contracted payment issues or errors. Research and analyze claim discrepancies and recommend corrective action.

Portland, Or, Us

Self-motivated, analytical individual with great communication and leadership skills who seeks and enjoys responsibility. To obtain a position offering challenge, responsibility, and advancement opportunities while utilizing my knowledge and experience in reimbursement methodologies, network strategy/contracting, data analysis, reporting, configuration, testing, and project management.

Portland, Or, Us

Responsible for reporting for Provider Services, Provider Contracting and Provider Reimbursement. Responsible for building pricing methodologies in current claims system. Participated in new claims system project, duties included building provider agreements, testing and implementation. Provided support for Provider Relations Consultants and Provider Contracting.

Portland, Or, Us

Responsible for data analysis and reporting for Actuarial, Underwriting, Membership, Marketing and Business Intelligence. Participated in conversion mapping, testing, documenting and implementing new Data Warehouse. Worked with various departments in analyzing and implementing new Data Warehouse.

San Francisco, California, Us

Participated in configuring, testing, documenting, implementing and supporting Loan Origination Systems. Worked with various departments in analyzing and implementing the needs of the end user. Configured, tested and created an installation plan and participated in the rollout of the systems nationwide. Worked with the Development team to design and test new desktop applications and acted as a liaison between Business owners and the Development team. Worked directly with the Business Owners to determine and process the needs of the end user. Created, documented, and participated in the software rollout to over 300 users. Maintained loan origination system, including programming new and existing forms and performing system updates. Provided third level technical support to business end users.

San Francisco, California, Us

First level telephone and on-site support for over 1500 end users. Trouble-shoot technical situations with desktops, laptops, printers and networks. Installed, maintained and trained end users on different desktop applications. Maintained database and distribution of information to other departments at corporate headquarters. Participated in conversion and rollout projects nationwide. Provided account administration for end users, including creating new accounts, changing passwords, and maintaining Access database of end user information.