Matthew Y. Email & Phone Number

Atlanta, Georgia, United States

-Analysis, evaluation, and documentation of business processes-Workflow mapping, business requirement development and project management.-Development of advanced analysis templates and data analysis tools utilizing excel, pivots, vba, and MS access.-Development of project reports, including progress reporting, time and budget reports.-Transform complex health insurance data into appropriate formats to evaluate market conduct and compliance.-Assist in the development of business process documentation, examiner guides,and training materials.-Presenting analysis findings to leadership and examiners to aid in the determination of market compliance or non-compliance.-Development of data migration and collection tools between SmartSheets, MS Access tables, Power BI and excel.

Louisville, Kentucky, United States

-Successfully contributed to the development of the Billing and Enrollments go-live strategy by determining need, taking ownership, designing end to end processes, (UAT & SIT) testing and consulting with IT resources, vendors and stakeholders.-Led a team of professionals in the execution of this strategy and implementation of all pre go-live processes, reports and operational task.-Developed and implemented several automation tools for increased efficiency and capture data points/trends/metrics/KPIs including automated templates, query design and Power BI dashboard development.-Partnered with IT, Interop, CDF and external vendors to acquire needed data points, develop reports and resolve systematic issues.-Constantly re-engineering processes as new data/automation tools becomes available to reduce manual touches/error rates and increase overall quality.-Directly responsible for the data integrity of Author’s claim system’s (HRP) and Author’s CRM (Sugar) in relation to plan level data, member demographics data, member preference data, LIS data, ESRD data, Hospice data and other CMS data points. Success in this area is critical to downstream systems such as UM, G&A and member communications/CMS compliance.-Conduct complex data analysis to identify trends, irregularities and/or to determine issue root cause.-Led several projects and initiatives in relation to process enhancements, new process design and overall business needs including HRP PCP logic reconfigurations, staffing model development and member preference API error reduction.

Louisville, Kentucky Area

-Developed new processes and tools to aid in the completion of regulatory filings.-Managed implementation and design projects concerning new processes and improvements.-Analyzed and interpreted large datasets into state mandated formats.-Organized and designed monthly, quarterly and ad-hoc dashboards, metrics (KPI) and staffing models.-Presented and translated dashboard metrics to leadership. -Reviewed and analyzed regulations to determine impact and requirements.-Coordinated mandated Commercial and Medicare reports to maintain compliance with state regulations and statutes. -Designed and implemented data driven database tools for automation, quality control and/or trend analysis-Extensive involvement in state All-Payer Claims Database (APCD), prompt-pay state surcharge, utilization, grievance, NAIC market conduct and CMS reporting.-Developed new policies and procedure documentation to aid in the completing of state and federal filings, onboarding, internal guidelines, etc.

Louisville, Kentucky Area

-Managed and developed relationships with CMS, DOI, NAIC and state vendors.-Coordinate mandated Commercial, Medicaid and Medicare reports to maintain compliance with state regulations and/or contracts.-Consulted with business partners to obtain necessary data and information to meet regulators mandates.-Developed and maintained relationships with internal and external stake holders.-Extensive experience with Microsoft Office, Microsoft word, Excel (VBA), MS Access, state department systems, CMS (HPMS) online systems and several internal systems.-Partnered with IT to develop complex SQL scripts based on state and federal requirements.-Designed and implemented data driven database tools for automation, quality control and/or trend analysis.-Extensive involvement in state All-Payer Claims Database (APCD), state surcharge, utilization, grievance, NAIC market conduct and CMS reporting.

Louisville, Kentucky Area

-Enrolling members into selected plans. Specializing in Medicaid and Medicare Supplement plan enrollment.-Resolving escalated issues, responding to member and management request.-Resolving incomplete issues, communicating with members, agents, and other associates to resolve enrollment issues.-Training associates on Medicare Supplement work.-Extensive experience with Microsoft Office, Microsoft word, Excel, Access, and several internal systems.

Louisville, Kentucky Area

-Developing marketing and promotion materials for fundraising events.-Market, promote and execute events and promotions.-Organize and direct volunteers to complete desired tasks.-Attend, socialize, and promote Kosair Charities during promotional events.-Communicate and maintain relationships with donors, volunteers, and local agencies.

-Managed a fast paced, high volume center with the responsibility of delivering high quality customer service along with high quality products for a fortune 500 company.-Training, leading and developing a team of employees to achieve personal goals and exceeding company profit goals.-Delivering profits in excess of 110% of projected plan.-Developing employees to advance and grow within the company.-Responsible for enforcing company policies, morals, visions, and values.-Developing and enforcing action plans, training programs and disciplinary programs.-Responsible for maintaining business to business clients and contact between corporate and retail locations.-Handling customer and employee issues.-Maintaining government and corporate regulations and records.-Responsible for maintaining and improving facility and equipment.

Louisville, Kentucky Area

-Assuming all Service Center Manager’s duties in absence of the manager.-Attending Management training sessions at corporate office.

Bachelor Of Science - Bs, Communications

Business Administration And Management, General