Business, Systems, and Data Analyst

Catherine Shay Irwin

**** *. ******* #** • Orange, CA 92869 • 714-***-**** • *********@*****.***

Core Proficiencies

• Product, Benefits, Fee Schedule, and Medical Coding Set Up Analyst / Auditor.

• Claims, Eligibility, and Provider Coordinator/ Analyst with five years of experience working with front-end and back-end TriZetto’s Facets Application (Versions 2x to 4x…).

• Over five years of administrative and analysis experience in the healthcare industry.

• Analyst with more than five years experience in operations environments.

• Five years experience in mental health and human services industry.

• Excellent written, verbal, and inter-personal communication skills.

• Productivity software proficiency including: MS DOS & Windows – NT, 2000, XP; MS Office 97-2007 including: Excel, Word, PowerPoint, Access, Outlook, Visio Professional.

• Experience with other healthcare practice management systems including: NICE, ILLIAD, DIAMOND, and MC400.

• Business, financial, technical, and policy research and analysis as well as new business implementations.

Professional Experience

October 2009-April 2010 Enrollment and Reconciliation Analyst, SCAN Health Plan (Long Beach, CA)

• Functioned as Primary Reconciliation Analyst for eligibility and Low-income subsidy (LIS) data reconciliation.

• Led implementation of new Medicare policies on a company wide basis.

• Worked with pharmacy department to ensure all Medicare Part D discrepancy issues were addressed in a timely manner.

• Created QA queries to correct issues for daily Medicare submission.

• Reviewed MMR, MOR, and TRR reports.

March 2004-February 2009 Business Analyst, United / PacifiCare Behavioral Health, (Costa Mesa, CA)

• Functioned as a product and benefits analyst as well as an eligibility and provider coordinator. Worked closely with IT on new business implementations, requirements building, and new program deployments.

• Functioned as the auditing analyst in the Product and Provider departments by building and utilizing queries based on back-end Facets tables.

• Also proficient with application support, claims processing, and customer service modules in Facets.

• Participated as lead analyst in the organization of major new business implementation spanning across three different States (Arizona, Nevada, Colorado, Oregon), and assisted with the maintenance of existing implementations across several other States.

• Proficient in inter-departmental interaction with IT, Claims, Clinical, Customer Service, Provider Operations, Account Management, Sales, and Finance / Accounting departments as well as with outside Healthplan administrators.

• Reduced costs and manual work by Claims and Account Management departments by successful reconfiguration of product and benefit builds in Facets.

• Responsible for manual eligibility, coordination of benefits, and other eligibility requests.

• Communicated directly with members and insurance plans on a day-to-day basis in order to obtain information and address requests from various departments.

May 2000-June 2003 Program Coordinator and Lead Counselor, Straight Talk-Gerry House, (Santa Ana, CA)

• Supervised counselor staff of 12-bed residential treatment facility.

• Responsible for managing facility operations, including scheduling, internal procedures, hiring, and training core staff.

• Served as liaison with program agencies and county services offices.

• Facilitated treatment and psycho-educational groups.

• Served as staff trainer in the absence of the Director.

Education:

• California State University Fullerton, May 1998

B.S. in Human Services

References Available Upon Request

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