Modify systems to meet client needs and conduct testing to verify client needs are met.Identify and reconcile errors in client data to ensure accurate eligibility input. Engage client to gather software requirements/business rules, and ensure alignment with development team.Weekly meetings with clients to document requirements and explore potential solutions to issues.Daily reporting to client on ID Card tracking

Analyze and Interpret provider contracts and pricing requirements, update systems to accurately apply contract details. Update customer specific documentation and reference materialsAssist with testing of information systems to ensure proper configuration of contracts and pricing. Participate in client meetings and related direct communication as needed. Provide support to internal and external customers regarding provider contract and pricing configuration. Set-up new provider contract and pricing arrangements Recommend changes in policies, procedures, or services to management based on benefit/contract changes. Create and maintain claims department documentation to support claims processingProvide testing results for new SpyGlass software.Training other departments in contractin loading into SpyGlassAssist wth new staff inquires and complex casesHandle complex high level issues and/or complaints from clients were applicablePerform audit udpates for new and existing contracts and pricing configuration.

Provide supply support and technical and logistics services to the Military Services, DOD agencies, Federal civil, and select foreign militaries. Reviewing contract status in Post Award and Enterprise Business Systems (EBS).Work Quality Notifications, which supports logistics needs, whether for combat readiness, emergency readiness, or day to day operations. Updating systems with ESD status. Updating assigned spreadsheets, Post Award Traking system (PATS), and completing administrative actions as required. Drafting of the following documentation: diversion modifications, First article testing (FAT) verifications, discrepancy resolution, and delivery extension modifications.Negotiating with contractors to ensure material is resupplied to military depots, CONUS as well as OCONUS. Created an Access database to track accomplishment dollars. This database has tracked over $2.5 million dollars in resupply material to date. Created an Access database to track Demand procedures. Responsible for assigning CRM (Customer Relationship Management) tickets to contract administrators. Back up administrator for the Demand ProceduresSufficient in Eprocurment, DIBBS, EBS, DAAS, SAP GUI, IDS, WEBSDR, SAMS, CRM.

Supervised four individuals all working independently on projects such as adding, changing and terming providers in the medical information system. Held weekly staff meetings to monitor progress toward completion deadline.Maintain internal demographics database utilizing information from doctor’s offices and monthly reports, Website Provider Directory, Medicaid & Medicare Provider directory.Handled Medicare and Medicaid sanctions reporting; Gather data from the state to monitor current panel providers and any possible sanctions, reviewed Medicaid website for updated fee schedules to populate Outpatient Hospital Handbook to ensure proper payments.Partnered with the quality and/or credentialing departments to do Monitoring. Communicated with Corporate office daily to ensure all new provider contracts are updated and processed within a timely manner. Load contract information into test region to verify proper setup for production, upload provider information into the state Provider Verification System.Created a tracking spreadsheet with new provider contract status for member and provider inquiriesResponsible for training new CIS and Provider Maintenance associates when coming to area, audit providers to ensure contract implementation is successful, initiate reporting to correct all provider payment issues.Handled all employee timesheets, and Performance Management

Building benefits in conjunction with plan contracts from clients, administration, IS and other entities, to insure correct claim adjudication and reporting.Responsible for updating RIMS for auto adjudication, system testing when new upgrades are added, updated system with ICD9 and new CPT codes, Adding DRG rates as well as per diem case rates to the RIMS system. System testing when new upgrades are added.Assist unit leader in plan clarification or manual claim issues, troubleshooting system problems then correcting them for proper claim payment.Responsible for recording benefit information on the web site for viewing & distribution to appropriate department personnel, physicians and employees, training departments in new system material. Update all on‐line manuals for customer service & analystviewing.Payment of medical claims