Stacy Wilson Applebaum Email & Phone Number

Hartford, Connecticut, US

Claims Denial work stream lead responsible for reducing member and provider abrasion associated with claims adjudication Review member phone calls, identify pain points, and propose solutions to increase call deflectionModify current member and provider Explanation of Benefit (EOB) remark codes to include newly identified program tenants and softer.

Product Management consultant for government and commercial software implementations, providing services for health plans nationwide

Hampton Roads, VA, US

Full time consultant responsible for the implementation of Commercial and Virginia Medicaid claims system Managed the procurement and contracting efforts with vendors (ID Card and report/extracts)Coordinated workstream efforts within business owners and team resources on enterprise level initiativesSupervised/mentored business analysts in best practices.

Pittsburgh, Pennsylvania, US

Senior configuration analyst responsible for provider pricing for the Medicaid Business Unit (within an agile environment)Reviewed contracts for compliance per Medicaid regulations and company standardsManaged the configuration of key provider contracts including the Delaware Chiropractic Services Network, Federally Qualified Health Centers, and School.

Pittsburgh, Pennsylvania, US

Senior configuration analyst responsible for provider pricing for the Delaware and West Virginia Medicaid plansLed the Operations Stabilization project for all WV Medicaid pricing inquiriesCollaborated with the Claims, Provider Relations, Provider contracting, and Provider Information Management departments on high visibility resolutions for large hospital.

Richardson, Texas, US

Senior business analyst responsible for the creation and implementation of Business RequirementsPerformed discovery sessions with team leaders and key stakeholdersDesigned Customer Service, Care Management, and Member ID card Business Requirement DocumentationFacilitated BRD Review sessions

Senior Business Analyst responsible for the successful implementation of a new software system, focusing on the Interface team, Provider Portal module, and the California Children Services ProgramCreated functional requirement specification documentation for developers to identify inbound and outbound files Developed Claims, Transactional Services, and.

Amherst, New York, US

Senior business analyst responsible for process improvement and complianceCreated enrollment, provider network, and claims policies and procedures for the Colorado Exchange and Alabama Federally Facilitated Marketplace (FFM) Documented business and functional requirements to facilitate software configuration for the Alabama FFM enrollmentUpdated.

Senior level healthcare SME responsible for business process optimization based on the changing needs of the health plan organization, concentrating on the interface between business and technical departmentsDocumented business and functional requirements for Medicare, Medi-Cal, and commercial lines of business Interpreted regulatory guidelines to validate.

East Norriton, PA, US

Member and Provider Call Center team lead responsible for providing an assessment of all current business processes for startup or existing health plansCreated business process workflows and gap analyses to increase compliance with local, state, and industry standardsAnalyzed and updated retention and and feedback processes to impvoe member satisfaction.

Business Analyst SME responsible for delivering comprehensive analysis, training, testing, vendor management, documentation, and configuration support to various startup or existing Medicare and Medicaid health plans Developed best practices to improve business performanceLed a product work stream for a multi-state healthcare exchangeReviewed state and.