Tracey Williams, Mba Email & Phone Number

Atlanta, Ga, Us

Atlanta, Ga

• Perform payment policy research to evaluate industry changes or client policyrequests to determine if company Rules Engine logic should be extended;• Define and document business requirements for new solutions development and opportunities and solutions maintenance projects;• Collaborate with Operations and IT teams to determine appropriate process and technologysolutions to deliver solutions initiatives;• Subject Matter Expert (SME) for payment policies identified and developed;• Draft internal solutions and training documentation;• Provide ideas, input and implementation support for new solutions and processes;• Plan and perform User Acceptance Testing for IT Solutions development projects;• Support the design process for Solutions enhancements;• Build and extends internal client relationships with Operations and IT teams; and• Develop, present and distribute Solutions communications and process knowledge for newly implemented and updated savings opportunities.

Atlanta, Ga

Atlanta, Ga

• Sr. BA/UAT Tester for the ICD-10 Medicaid MIS Claims system remediation;• Assisted the PM in the project planning providing input of estimates of time, effort, resources, etc.;• Advise and mentor project team members on various project and BA functions (i.e. facilitating client sessions, documentation, testing); • Liaison between the Business and Systems Owners for interpreting and documenting business rules and policy;• Facilitated client sessions to gather ICD-10 business requirements (planning phase);• Developed and maintained the requirements via the Requirements and Traceability matrix;• Created BRDs, design documentation and test plans for various MMIS subsystems;• Developed test plans, scenarios and test cases for Change Order (CO) based testing for assigned policy contracts;• Work closely with systems, business owners and the MMIS vendor to resolve testing and policy and configuration issues;• Review and interpret policy manuals, system business rules, contract billing rules, edit/audit rule configuration and reimbursement rules to determine test pass/failure and to identify and track defects;• Assist with the Cross-Functional, End-to-End testing effort and QA Lead;• Administrator of the testing management software (SpiraTest) responsible for user accounts, developing and maintaining user documentation, as well as, data integrity (QA); • Conduct User Training for Test Management application for project and client staff; and• Designed and executed daily and weekly reports for project data and statistical reporting via Business Objects and SQL, SpiraTest and MS Excel utilizing Pivot Tables, VLookups, Macros etc., MS Access

Virginia Beach, Va

• Business Analyst for the Medicare LOB responsible for maintaining Medicare Advantage Plans (MAPs) covering seven (7) markets;• Performed requirements gathering and Medicare policy research via CMS online manuals, MLNs and transmittals to ensure company compliance of federal healthcare regulations;• Facilitated weekly Health Plan Services (HPS) meetings to discuss corporate compliance and impact and regulatory updates for the Medicare LOB;• Maintained the Pricing and Benefits requirements documents through the initiation and tracking of Requirements Change Documents (RCDs) and Amerigroup Configuration Change Requests (ACCRs) for BRD and system configuration changes;• Developed and maintained the MAP annual Benefit Summaries and Plan IDs for system configuration; • Utilized Rational ClearQuest and FACETS applications to track, manage and test requirement and configuration changes prior to production migration; and• BA assigned to gather requirements and developed the BRD for several corporate projects including the Resource-Based Relative Value Scale (RBRVS) system implementation and the Trizetto NetworX Modeler application.

Tallahassee, Florida Area

• Manager of the Medicare Buy-In (Dual Eligibles) Operations Unit processing Medicare premium payments of $75M per month; • Business liaison between the State and external clients including CMS, SSA, and the RRB;• Defined and implemented the operations business process, structure and improvement strategies;• Created and maintained the State approved Buy-In Program BRD;• Developed and facilitated the program training and development to staff, internal and external clients;• Monitored system transactions and files and delegated work to ensure proper processing and program compliance of CMS and State policy and regulations;• Developed and implemented the QA initiative and audited program operations to ensure the integrity of the data and financials; • Consistently met and exceeded all monthly deliverables and contracted SLA requirements;• Assisted my HP State of Georgia counterpart in the GA MMIS implementation project.Business Services Analyst, Development June 2007 – June 2008• SME for Member functional and operational processes during the development and testing phase of the MMIS implementation;• Conducted client meetings to gather and document system requirements and specifications;• Performed system testing for the Claims, Member and Eligibility subsystems; and• Identified and tracked system defects utilizing the HP Interactive Portal, Information Tracking Repository Portal (iTrace) and SharePoint application tools.

Thomasville, Ga

• Researched and analyzed managed care and provider pricing contracts for pricing logic, claims adjudication and collections;• Audited claims and patient accounts for proper reimbursement;• Performed account collections on commercial payers for underpayments;• Reviewed claim denials to identify and report issues, trends and process improvement areas;• Assisted in staff training on billing and reimbursement policy; • Gained expert knowledge in reimbursement methodologies (i.e. DRG, APC, Fee Schedules); and• Developed reports via MS Excel and Access on financial and statistical trends for senior management.

Master Of Business Administration (Mba), Business Administration And Management, General

Activities and Societies: Professional Management Association, President, Thomas University Chapter Studied Abroad, France and Belgium.

B.S. Business Administration, Management

Activities and Societies: Professional Management Association

Bachelor Of Science (B.S.), Business Administration And Management, General