Bachelor's Degree in Business Administration; Strong report development and analytical skills; Strong organizational and analytical skills Project management experience; Technical reporting background. Self-managed and resourceful; Excellent written and verbal communication skills; Proficient in Microsoft Office; Proven research and problem solving; skills Detail-oriented. Responsible Business Analyst with excellent communication skills demonstrated by 25 years of experience in healthcare.
Exceptional customer service
Willing to learn new skills
Willing to pursue additional certification
successfully re-vamped the provider termination process and created a totally automated process to terminate provider participation and send related letters.
November 2013 to Current
Optima HealthBusiness Analyst
Coordinate, lead and facilitate requirements gathering meetings for new customer operations team projects Coordinate and facilitate process meetings across cross- functional work groups Prepare meeting minutes and project plans Generate reports, research and analyze data to determine best case outcomes Apply logical thought and policy process to identify and resolve data discrepancies Lead electronic eligibility implementation data and file process based on established policies Audit enrollment and eligibility transactions Prepare and present report results orally and in writing to Customer Operations Director Marketing Communications.
April 2005 to November 2013
Coordinated, lead, and executed communication plans for Optima Health business initiatives Coordinated and facilitated audit process meetings across cross- functional work groups Prepared and created health plan benefit materials for Brokers, Benefit Administrators, Members, and Plan Providers.
Interpreted government guidelines to create and publish summary of benefits Created and audited compliance documents for member distribution Responded to member and broker inquiries regarding filed insurance plan benefits as filed with the Bureau of Insurance.
Prepared necessary documents for inclusion in client contracts.
Created small group employer client contracts.
Created, prepared, and maintained Access database as central source for benefit materials and information for distribution on the health plan website.
Developed and updated functional area policies and procedures as needed.
Collaborated with other functional areas to ensure policies and procedures were accurate and consistent with benefits administration and system set-up.
Facilitated routine audit committee meetings between Sales Operations, Legal and Compliance, Product Development, and Systems Administration to review and maintain benefit accuracy and consistency.
Made either benefit or policy recommendations as needed.
Created, prepared, and maintained reports for membership, benefits, and group specific analysis.
Acted as a benefit materials resource expert for other departments.
Developed and maintained Access benefit database for internal and external benefit communications.
Generated monthly group renewal list to facilitate enrollment on a health plan website.
June 1998 to April 2005
Sentara Health ManagementGroup Service Representative
Assisted Sales and Marketing teams in attendance at broker and employer group meetings to respond to questions regarding benefit clarification or claims resolution.
Facilitated, organized and lead member enrollment meetings.
Provided exceptional customer service to Broker and Employer customers as needed via telephone or through face to face meetings.
Researched, analyzed and resolved service issues relating to claims, billing, pharmacy and health plan benefits.
Acted as a liaison between Sales/Marketing and Operations teams.
October 1994 to June 1998
Optima Health PlanVirginia Beach, VAAccount Service Analyst
Assisted in claims processing and customer issue resolution.
Provided new group enrollment-system setup.
Performed data entry for membership enrollment applications.
Posted and balanced monthly group payments.
Trained new employees.
Prepared and forwarded monthly billing to segmented groups.
Education and Training
Saint Leo University Chesapeake, VA, USABusiness Administration Bachelor of ArtsBusiness Administration Foundations of Leadership - Track 1, Sentara University PLMS Courses include "Peer Today, Boss Tomorrow", Communication Skills, Presentation Skills, Understanding Conflict, Generations in the Workplace, and Career Enhancement