Collaborate with senior clinical leadership to advance various initiatives for anesthesia integrations related to the use of iPro Coreand iPro Lite. Design and execute diverse testing methodologies, including Data Integration and Migration, Usability, and UserAcceptance testing. Implement payroll register within Oracle Cloud for both operational and IT purposes. Coordinate meetings andmanagement efforts for ERP initiatives, while overseeing vendor resources. Employ diverse project management methodologies tomeet goals for testing and training initiatives in anesthesia integrations.• Developed and implemented new methodologies for testing and training initiatives for iPro Core and iPro Lite.• Optimized all processes for testing and training for iPro Core, while supporting PMO in additional projects as required.• Executed various testing methodologies, covering Data Integration and Migration, Usability, and User Acceptance testing.• Supported ERP Oracle Integration Testing by defining Error Assessment and Error Handling for around 90 integrations.• Utilized agile methodologies to plan development sprints for specific deliverables with within the Oracle ERP Framework,including, but not limited to software and platform design, configuration, data migration, and interface development.• Developed and established all tools and tracking mechanisms for the ERP HCM Payroll Oracle Integration initiative.• Completed ERP Finance initiative and all User Acceptance Testing successfully.

Strategic Account ExecutiveServed as domain expert on Sentry’s software platform to support systems integration and patient data management for Account Management teams. Coordinated with relevant parties on performance, reprocessing efforts, and special projects. Offered expertise, consultation, optimization, and remediation efforts to PMO to ensure outcomes meet expectations. Provided guidance for improving processes, staffing, and systems. Participated in developing proactive and automated monitoring tools to ensure client program success and preempt data issues. Leveraged knowledge to recommend technical improvements for DS applications.• Evaluated business processes, conducted root cause research, identified areas for improvement, and implemented solutions to enhance quality and profitability.• Identified, analyzed, and interpreted trends or patterns in complex data sets.• Developed and implemented data collection systems and strategies optimizing statistical efficiency and data quality.• Prioritized initiatives based on business needs and requirements while managing competing resources and priorities.

Senior Business Analyst III / Project ManagerPerformed data analytics to ensure accuracy and operationalization of incoming facility data. Utilized broad knowledge of healthcare administration processes to provide insight into implementing complex systems. Leveraged understanding of healthcare contracts and claims systems to ensure smooth operational processes. Defined testing methodologies and draft documentation for new system implementations. Defined KPI metrics for various IT and operational initiatives.• Streamlined current and future state workflows based on business and functional requirements.• Created data flows for existing and newly implemented interfaces from healthcare facilities to the organization.• Conducted testing methodologies, including UAT, data integration and migration, usability, and user acceptance testing.• Developed HL7 mapping documents, specifications for downstream data systems, and gap analyses.

Senior Business AnalystEvaluated and audited existing workflows and standard operating procedures to identified areas for enhancement. Applied expertise in practice management systems to design wireframes for medical record requests, claims tracking, and payment. Utilized healthcare administration knowledge to offer insights for the Payor Inclusive Initiative. Leveraged understanding of healthcare contracts, claims, and claims systems to optimize processes.• Formulated policies and standard operating procedures to support key business initiatives.• Developed end-user guides to assist newly recruited physicians with the credentialing process.• Designed business requirements for new payors to integrate functional requirements as needed.

Business Data Analyst - ConsultantActed as Administrator and Database Owner for Business Intelligence tools. Utilized databases to retrieve usage data for specific requirements, carriers, and subscribers. Collected requirements for data warehouse and platform updates from stakeholders. Collaborated with IT development to update databases as needed.• Addressed queries using multiple business intelligence tools such as Cognos, MySQL (DWPROD, CLARIFY, MAX, and MAXLite).• Reconciled reports from phone technology carriers to identify any changes or updates for all subscribers.• Tracked and analyzed historical data using KPIs and scorecards, and represented findings graphically.

Led project management efforts including planning, programming, and consulting. Managed access for all clients and internal users to Business Intelligence tools and customized reports. Utilized Cognos reporting system and other business intelligence tools to compile and generate various reports for clients and internal operational and financial departments. Applied knowledge of HIPAA EDI formats to support the master insurance table/allowable project. Oversaw consolidation of information from multiple servers and databases into tables for querying and report building. Employed SQL to create tables and queries from data across 100 different databases.• Analyzed historical data using KPIs and scorecards by representing results graphically as needed.• Developed tables and queries to leverage business intelligence tools such as Cognos, Practice Analytics, and Business Objects.• Drafted SDLC project plans for new platform and master table implementations.• Established standardizations and processes for user access and permissions.

Short Term Contract

Various claim analyses, business intelligence, other various analyses in healthcare, medical appeal and contract specialist, EDI analysis, general clerical work as it relates to the healthcare administration field. Additional knowledge in various BI and healthcare systems as well as general clerical duties.

• Monitor Intergy systems to ensure correct programming to support community health centers• Monitor HEAT cases submitted by HCN staff or RCM Center Staff for Intergy system corrections to facilitate claims submission, correct providers, and/or updates in Procedure Codes, Formats, General Ledger, Profiles, or Fee Schedules• Manage Intergy for 15 centers to ensure correct reporting for UDS, General Ledger, and Accounts Receivables• Ensure all 15 centers have correct Intergy setup to facilitate appropriate FQHC billing• Utilize Florida Medicaid knowledge and contacts to facilitate RCM billing• Utilize Medicare knowledge base to facilitate RCM Billing• Analyze managed care contracts to ensure appropriate setup for each insurance plan in Intergy• Analyze managed care contracts and load all appropriate fee schedules • Perform analysis and identify programming issues with fee schedule loading, provider loading, profile loading, sliding fee schedule loading, and insurance loading • Ensure all claim formats are in compliance for 5010 and all Medicaid and Medicare formats• Lead on ERA initiative – automatic payment allocation via Intergy ERA portal• Lead on ICD-10 initiative – ensure Intergy and systems are prepared for new formats for ICD-10• Formulate system standards for Intergy loading of providers, claim formats, fee schedules, profiles, procedures, and insurance plans• Utilize and formulate reports to monitor RCM Center systems to ensure compliance and correct setup

• Ensured compliance specialist goals are met regarding account resolution and managed care payment • Prepared legal cases against managed care plans for lack of appropriate payment per contract utilizing hospital claims and patient systems such as Epic, Mainframe, and Sovera.• Managed several contract compliance specialists and filing clerks• Department expert on Florida Medicaid policies, procedures, and billing requirements• Utilized Florida Medicaid knowledge and contacts to obtain over 2.5 million dollars in old unpaid claims that were initially denied for timely or billing issues• Performed case by case research on in depth medical cases that are involved in non payment• Analyzed medical records in order to appeal appropriate cases and build cases against managed care plans• Analyzed managed care contracts to ensure appropriate payment for hospital and professional claims• Performed trend analysis and identify claim payment issues for different managed care payers that surround issues with billing, utilization management, and authorization insufficiencies• Performed audits on work performance and accuracy for employees• Prepared appeals and underpayments to managed care plans regarding loss of payment surrounding medical or billing issues• Performed coverage changes as it pertains to correct distribution of managed care funds• Performed analysis and reporting to Executive Director regarding department goals, targets, account volume with its corresponding monetary volume

• Functioned as liaison between the health plan and the participating provider network• Performed accurate, detailed orientations for all provider types• Understood and relayed current policies about benefit administration, enrollment, claims adjudication, utilization management, quality management, credentialing, provider contracting and reimbursement to health plan providers• Functioned as a liaison between health plan and the state agency (AHCA) in regards to policy changes • Managed and lead for NPI implementation for health plan utilizing state and federal files and contacts • Oversaw and maintained delegated provider network relationships• Ensured accuracy of provider data for in network and out of network providers• Responsible for all delegation oversight responsibilities (auditing, contracting, provider updates, and claims)• Produced yearly provider directory• Produced monthly provider directory updates (provider directory addendum)• Performed claims research utilizing Florida state file (ERV- Electronic Remittance Voucher, 837P and 837I transactions)• Educated providers on accurate claims processing utilizing CMS1500, UB-04 claim forms, and HIPAA transactions (837P, 837I, 835, and 270/271)• Recruited providers into the health plan network• Ensured potential provider applications are submitted through appropriate channels including credentialing system loading of provider information• Performed in-services for providers for the purpose of orienting new staff, communicating policy changes, gathering or presenting statistical and financial data• Coordinated and implemented all aspects of provider workshops, seminars and meetings• Maintained accurate concise records of all provider contracts2008 – 2009: Acting Director of Provider Relations2009 - 2010: Transferred to Centene Corporation through sale of Pediatric Associates Health Plan

• Responsible for investment reporting• Managed national sales team and ensured appropriate staffing utilizing sales and sleep lab volumes• Managed and organized sales reports, sales quantities and numbers, commission reports• Organized monetary investments for all investors, including market shares and cash amounts • Responsible for supply and demand analysis for appropriate ordering from manufacturers• Performed trending analysis for patient utilization at sleep labs• Designed and compiled Access databases to organize operations, product purchasing, and investment logistics• Organized investor portfolios and database• Organized Access Database for all customers and 3,000 sleep study labs• Prepared presentations for investors and clients• Prepared all in services at all local sleep labs