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Reference Data Maintenance - Manager Resume Example

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REFERENCE DATA MAINTENANCE - MANAGER
Professional Summary
Dependable Business Operations Leader, bringing management experience and a willingness to take on added responsibility to meet tight deadlines. Enthusiastic team player with a strong work ethic and advanced complex problem solving skills. Extremely results-oriented and proactive in addressing and resolving problems.
Skills
  • Seventeen plus years' experience in Healthcare industry
  • Strong leadership skills
  • Highly self-motivated
  • Team-oriented individual
  • Proficient in ability to take initiative and resolve complex situations.
  • Exceptional interpersonal communication
  • Efficient multi-tasker
  • Project management
  • Customer service-oriented
    • Staff training/development
    • Employee scheduling
    • Consistently meet goals
    • Organized
    • Deadline-oriented
    • Proficient with 10 key, able to type 75 wpm
    • Multilingual in English, American Sign Language (ASL) and Cambodian
    • Experienced with Microsoft Office (Windows, Excel and PowerPoint)
    Work History
    Reference Data Maintenance - Manager, 07/2016 to Current
    Freeport Health Network – Freeport , IL
    • Manage a team of up to 28 professionals
    • Prepared detailed status reports on all ongoing projects.
    • Coordinated with all relevant parties to ensure seamless project completion.
    • Trained, coached and mentor staff to ensure smooth adoption of new policies.
    • Developed and rolled out new Procedures and Processes and job aides to assist new and existing staff with responsibilities and roles.
    • Recruited hired and trained team staff members.
    • Organized financial data and prepared related projections and budgets.
    • Assigned and managed project activities per client standards.
    • Monitored project progress and addressed client issues.

    Reference Data Maintenance - Supervisor, 03/2013 to 06/2016
    ACCENTURE LLC – City , STATE
    • Manage a team of 15 professionals.
    • Supervise effective working of production personnel and prepare effective production schedules and ensure compliance to all company policies.
    • Interviewed trained and assigned positions to new hires.
    • Supported various business processes in a timely manner while ensuring quality.
    • Prepare vacation schedule for all employees maintaining continuous production.
    • Attend and provide input for work area at internal/external meetings.
    • Ensure compliance to all local policies to achieve all production objectives and provide appropriate feedback to all employees.
    • Responded to customer State Action Request (SAR).
    • Provided pertinent productivity data to leadership for projections and budgets.

    NOTE: Supervisor from March 2013 - July 2014 under XEROX/ACS STATE HEALTHCARE

    ​

    Reference File - Sr. Business Analyst, 06/2005 to 02/2013
    XEROX/ACS STATE HEALTHCARE – City , STATE
    • Perform updates on data records to Compass 21 (C21) system by building data sheet(s) using microsoft excel.
    • Maintained team's policies and procedures and work instructions.
    • Perform extensive research and analysis on C21 system to assist client in developing policies.
    • Respond to and complete State Action Request (SAR) initiated by State customers.
    • Provided staff from other internal departments with expertise analysis to help with resolving issues related to C21 system.
    • Developed training guidelines to train new and existing employees.
    • Conduct and attend workgroup meeting(s) providing expertise input for work area.
    • Monitored project progress and addressed client issues.
    • Developed and implemented test plans and user acceptance testing (UAT) to ensure project accuracy.
    • Lead and coordinated major projects such as Annual ICD and Annual HCPCS.

    Subject Matter Expert (SME) Claims Analyst, 12/2003 to 05/2005
    XEROX/ACS STATE HEALTHCARE – City , STATE
    • Back up to leadership when needed. 
    • Trained new employees on the C21 Claims processing system to ensure claims are processed accurately and timely.
    • Responsible for meeting the required performance standards for productivity and quality as established by the immediate leadership and approved by department manager.
    • Maintained up-to-date knowledge of the Medicaid billing procedures and policy.
    • Assisted peers within the department with complex issues and questions.
    • Prepared and provided daily production reports to leadership.
    • Assisted other departments with research questions concerning billing issues.
    • Knowledge in over 100 edits and audits.

    ​

    Claims Analyst, 10/2000 to 11/2003
    Electronic Data Systems EDS – City , STATE
    • Proficient in adjudicating professional and outpatient claims in Compass 21 (C21) System & MMIS (Medicaid Management Informational System).
    • Maintained team inventory in a timely manner.
    • Keyed in pre-system (batches not yet keyed into system).
    • Knowledge in over 50 edits and audits.
    • Successfully trained in back end and front end claims processing.
    • Assisted customer service with questions concerning claims.



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    Resume Overview

    Job Titles Held:

    • Reference Data Maintenance - Manager
    • Reference Data Maintenance - Supervisor
    • Reference File - Sr. Business Analyst
    • Subject Matter Expert (SME) Claims Analyst
    • Claims Analyst

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