Reimbursement Specialist
CurrentReimbursement Specialist & Analyst, Finance Department (2007 - Present)* Lead on special projects with focus on government programs (Medicare, Medicaid, CHIP) & Commercial products* Project Lead on Shared Savings & Care Coordination Fee program implementation-responsible for validating membership rosters; user acceptance testing (UAT) of data warehouse tables; analyzing, updating, and testing of imputation code logic; & automation of reports utilizing Oracle SQL (Toad for Oracle), VBA (Visual Basic for Applications), MS Excel, & MS SharePoint, as well as creating the internal Policy & Procedure Manuals and technical documentation* Produce detailed analytical reports and financial impact analyses using Oracle SQL, MS Excel, VBA, MS Access, MS Word, Cognos, & MS PowerPoint to measure provider performance in regard to quality and effectiveness of medical services and care, to identify utilization patterns, and to ensure market competitiveness* Design, analyze, & implement reimbursement models for risk/incentive contracting.* Prepare requests for proposals (RFPs) for employer groups* Identify issues involving documentation, coding, and billing to improve efficiency & effectiveness of practice managementBusiness Analyst II, Department of Health Economics (2006 - 2007)* Produced detailed analytical reports of clinical and financial data to compare operating performance against regional and national benchmarks including HEDIS measures* Identified trends in expenses, utilization, and medical quality, as well as identified potential fraud & abuse and cost/benefit analysesAnalyst I, Underwriting & Actuarial Services (2005 - 2006)* Designed, created, and maintained computer programs using VBA to automate the renewal underwriting processStaff Underwriter, Underwriting & Actuarial Services (2005)* Monitored regulatory changes and implemented updates to the risk assessment and rating process to ensure compliance with local, state, and federal regulations
