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senior group configuration analyst resume example with 13+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - resumesample@example.com - : - -
Summary
10+ years experience in the Healthcare industry 10+ years of administrative experience in both corporate and provider office environment Business Analysis experience with in-depth knowledge of business processes Proven ability to work effectively and interact appropriately with various levels of the organization and associated departments to meet business needs Cultivate rapport with vendors, corporate management, and community organizations to improve brand image and maximize revenues Proven success in meeting deadlines while managing multiple projects at various levels
Skills
Comprehensive knowledge of and experience with the following systems: FileMaker, Facets Production, Microsoft Office (Word and Excel), AS400, CRM, Visio Strong verbal, written, and interpersonal communication skills
Experience
07/2010 to 07/2016
Senior Group Configuration Analyst Dentaquest Redmond, OR,
  • Responsible for configuring member benefit plans into Facets System accurately and consistently with contractual agreements made with the group.
  • Acts as the liaison between group configuration and new or existing clients, to ensure that all business application along with technical-oriented issues are appropriately addressed.
  • Successfully maintained accuracy and efficiency rating that resulted in decrease member disruption during group processing Appropriately audit patient demographic, rates, benefits, and commission prior to health plan implementation.
  • Answers inquiries from Medical or Dental claims departments, Underwriting, Marketing, Professional Relations and Business Implementation Unit regarding contract and product set-up issues on medical or Dental group business.
  • Ensuring that project management approaches are consistent, measurable, and aligned with corporate standards and best practices.
  • Responsible for maintaining complex compliance guardrails in renewing, termination, reinstatement, new line of business and member enrollment to accommodate group and Health Care Reform.
  • Manage weekly meetings to evaluate opportunities for process improvement and applied appropriate recommendations to enhance work-flow.
  • Organize all draft and filing documentation, decisions, resource materials for easy retrieval, review and reference.
  • Respond to information requests and represent team to address document issues in assigned benefits and product lines.
12/2008 to 06/2010
Provider Relations Representative Moda Health City, STATE,
  • Act as the liaison between provider and internal plan departments such as Claims, Credentialing, Audit, Marketing, Member and Provider Enrollment and Health Services.
  • Responsible for completing physician credentialing prior to implementation in Facets system.
  • Successfully processing over 45 claims per day and reaching our annual goal from 10,000 to 3,000.
  • Managed six team members in coordinating and completing mass mailings of physician contract and demographic amendments.
  • Responsible for training new hires to ensure that policy and procedures are met.
  • Updated Policy and Procedures to ensure Health Care Reform compliance.
  • Works collaboratively with managers in implementing and administering contractual provisions of provider agreement to ensure contractual compliance.
  • Use Facets Systems to update provider W2's to apply reimbursement accurately.
  • Contact provider offices to obtain Tax Identification and NPI number for regulations.
11/2006 to 11/2008
Treatment Coordinator/ Patient Relations Joseph J. Safirstein DDS PC City, STATE,
  • Managed office operations to keep clinic flow of an average of 55 patients per day in two separate offices.
  • Responsible for all initial exams and work with patient service representatives to assure patients are scheduled appropriately.
  • Educate and present patients on individual treatment plan for given diagnosis.
  • Negotiate agreeable finance options and execute sales contracts.
  • Responsible for monthly visits to high and low referring dental offices to sustain relationship and repeat business.
  • Verify patient insurance benefits, prepared contracts, handle billing and maintain meticulous patient charts.
  • Handle correspondence to patients and referring doctors.
  • Responsible for monitoring potential patients in FileMaker systems to ensure doctors goal of contracting at least eleven new patients per month.
  • Prepare detailed monthly reports for office managers and doctor for two separate offices.
08/2004 to 08/2006
Co-Owner/ Manager Cali Sandwiches City, STATE,
  • Successfully managed a full service restaurant with gross income of $8K+ per month.
  • Collaborated with community to create attractive and appetizing signature presentations as central component of menu and theme, substantially increasing repeat business.
  • Responsible for all marketing and advertising.
  • Established and developed key relationships with local vendors.
  • Led restaurant to recognition in Willamette Week.
  • Accountable for all aspects of budgeting, cost control, profit and loss.
  • Responsible for inventory, including purchasing from local wholesalers, along with forecasting food/beverage costs.
  • Supervised and arranged all catered events.
01/2003 to 08/2004
Student Fundraiser Portland State University City, STATE,
  • Served as a PSU ambassador to alumni and friends while helping raise much-needed support for scholarships, school supplies, and faculty recruitment.
  • Raised over $26,000 for annual giving though cold calling PSU alumni and parents.
  • Updated demographic information in system through "Campus Call" excel database.
  • Informed alumni and parents about current events, updates on campus, and solicited gifts for all departments.
Education and Training
Expected in 2004 to to
Bachelor of Science: Sociology & Social Science
Portland State University - Portland, Oregon
GPA:
Sociology & Social Science Portland Parks & Recreation
Skills
advertising, cold calling, filing, forecasting, process improvement, profit and loss, purchasing, sales, treatment plan, Underwriting
Activities and Honors

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Resume Overview

School Attended

  • Portland State University

Job Titles Held:

  • Senior Group Configuration Analyst
  • Provider Relations Representative
  • Treatment Coordinator/ Patient Relations
  • Co-Owner/ Manager
  • Student Fundraiser

Degrees

  • Bachelor of Science

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