A business and financial solutions company specializing in helping consumers with financial literacy/edu. Assist business owners with building and understand business credit and funding.

• Work with internal experts, senior management, stakeholders and business owners to develop/gather formal requirements, project planning, system design, and end-user documents in an iterative development environment• Collaborate with the project team to define, build, and rollout innovative technology and business process solutions to increase efficiency, and improve customer satisfaction.• Weigh / quantify trade-offs between business solution options and available technology options, ensuring that proposed solutions meet the business requirements• Collaborate, review, verify, and track software defects from any and all sources to ensure EMR is pulling correct information and producing proper output for reporting • Create test plans and traceable, detailed test cases mapping back to requirements.• Execute positive, negative, regression; post Implementation, for web applications and financial systems manually while maintaining the integrity of the testing data.

• Asst. in maintaining the quality and accuracy of a 15 member team of Financial Disposition Experts responsible for claims forensic, processing, manual adjudications and much more.• Research/Analyze high dollar refunds to determine reasons money was refunded to the Department –financial disposition request coming from DCH, GHP, DFCS, SSA, and CMS.• Apply analytical skills to support claims process improvement, data integrity, and projects regarding, but not limited to, claim team performance, overall department performance, training, and monitoring • Perform analysis to map refunds to correct patients, claims, providers, and determine how COB affects payout.• Responsible for running queries via Query Path and performing Mass Adjustments (500+ claims) based on business owner requirement – DCH( Dept. of Community Health)• Assist with developing test plans, UAT Testing, and online learning modules• Verify/ update & manually test CPT codes and ICD codes to ensure system is reading and paying out correctly while documenting and reporting test results and defects• Conduct audits and reviews of suspended claims, EOB, EOMB, TPL to ensure Medicaid payout is correct for claims that don’t automatically adjudicate. • Responsible for the accurate disposition of all claims refunds, gross levels, using MHN for various claims and SIR Web applications.• Accurately disposition healthcare claims, handle claim adjudication’s voids and adjustments

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