Create, update and maintain applications, databases and objects in all environments. Perform Data Validation and Quality Assurance to ensure data consistency with the various source systems. Create and maintain the generation of user created financial reports distributed among various levels of management for Optima Health departments. Identify and correct/prevent system anomalies, degradation and other issues by regularly analyzing system performance and utilization. Address and resolve Finance systems issues when possible and assist users with Access databases. Provide support to Financial Planning and Reporting for Finance reporting tools. Provide support to users for report development needs. Assist and Support A/R Reserves and Contractual Programs. Assist with User Training and Documentation, assist Project Manager with Process and System Improvement for Finance Reporting Tools, participate in Decision Support special projects as necessary.

Manage the credentialing team and the credentialing process to include initial credentialing and re-credentialing of behavioral health providers. Oversee performance reviews and budgets for the department and collaborate across teams to share information and facilitate compliance with NCQA and CMS. Develop and maintain credentialing policy in compliance with NCQA, CMS and all Federal/State regulations. Create credentialing manuals and processes for workflow and training. Hire, train, coach and develop new and existing staff. Identify potential system/process related issues and coordinate with other departments and outside vendors to improve and implement processes. Lead the credentialing team to improve production and quality, and maintain appropriate workflowPresent issue files and credentialing updates to National Credentialing Committee (NCC).

Manage the day to day activities of a Provider Data Management (PDM) team. This includes crisis escalation and resolution, establishment of operational procedures, and management of the PDM staff. Ensure clear operational and business communications to the frontline staff and partners within the business. Lead requirements gathering sessions with business owners to develop objective and goal oriented requirements, as related to provider data. Manage staff activities to meet project deadlines within budget and with high quality. Manage processes that consistently yield measurable improvements in the overall quality and cost effectiveness of services provided and ensure service levels meet agreed-upon standards with business owners. Recommend Policies and Procedures to govern the use of the PDM system. Ensure appropriate desk level aids are in place and their team members understand how to operate within the boundaries of the departmental policies and procedures. In addition to configured and maintained provider information and supported the ongoing maintenance and data integrity of provider configuration and provided in depth research and analysis as required. Gate keeper for providers demographic and financial affiliations, set up. Utilize reporting tools to monitor day to day progress towards operational and quality goals. Act as a subject matter expert in support of new market implementations, market expansions, system conversions and interface development. Act as a subject matter expert in support of internal and external audits. Set, manage, and review performance goals and career management of staff.

Responsible for requirements gathering, analysis, and process and data flow diagramming for simple process of low complexity. Support reimbursement policies and methodologies within Amerigroup Corporation. Perform simple to moderate queries with the basic understanding of database tables, relations, data types, and values. Provided data analysis support for new development projects and market expansions. Having basic knowledge of the inter-relationship among various managed care operational areas. Assist in development of test plans used to verify specific configuration functions according to actual requirements and established guidelines. Responsible for understanding functional areas of responsibility, gather requirements, perform analysis, support the development and testing processes, comprehension of applications and data utilized and associated technologies for supported areas. Development of training materials, and manage multiple priorities at the same time while adhering to departmental and corporate policies procedures.