PROFESSIONAL SUMMARY

Enthusiastic Project Coordinator, analyst and auditor with more than ten years’ experience on a variety of health care, insurance, and pharmacy projects

Expertise in analyzing, compiling, and validating crucial, confidential medical data

Proficient in a wide variety of software that specialize in data collection and analysis

Able to manage multiple simultaneous projects, as well as meet time constraints and expectations

Efficiently and effectively develop and prepare reports for upper-level management such as monthly status reports, medical claims costs, and prescription records

Skilled working with Microsoft suite, SharePoint for reporting needs

oFacilitated project budgets, forecasting, and budget variance analysis

oDeveloped reports using advanced excel skills, pivot tables and data analysis

oProficient in Microsoft Word, Excel, PowerPoint, Project

oSkilled in developing PowerPoint presentations and hosting meetings using conference bridges and WebEx tools

oWorked with SQL, SharePoint, RXclaim, UltraEdit

oExcellent communicator in varied corporate environments with the ability to work collaboratively or autonomously

oMaster at creating project plans, project schedules, and milestone tracking

oExperienced in selecting vendors and vendor management

Results-oriented with excellent experience working with all levels in corporate environment

TECHNICAL EXPERTISE

Software Implementation, Basic Java, Basic Oracle DBS, Microsoft Suite, RxClaim, SharePoint, FoxPro, Workforce Now, Trucare, Amisys, Microsoft Dynamics CSR, CMD Window Scripts, SQL, AS400 UltraEdit, Epro Analyst, Snag It, Onyx, Basic UNIX

PROFESSIONAL EXPERIENCE

Consulting Company, short term March 2018 to June 2018

CVS – Domestic Benefit Coder

Coded and learned the methods of analysis on drug claims

Ran Macros in RXclaim for upcoming data migration of new participants

Optum United Health Group, Schaumburg, IL April 2017 to January 2018

Senior Project Manager – Client Pharma Audit

Perform audits of Optum clients, collaborating with firms such as Truven and Mercer

Perform claims and adjudication analysis as well as internal audit of pharmacist credentialing requirements of network pharmacists

Develop audit plans and approaches including scoping special projects, developing controls and processes to ensure compliance and minimize financial risk

Coordinate system testing and contribute to development and implementation of data systems programming required to extract any requested data

Manage vendor collection activity

Interact with vendors to establish collection goals and reporting to ensure project milestones are hit

ADP For Futurewave Systems, Schaumburg, IL August 2016 to January 2017

Benefits Analyst (Contract)

Created and implemented benefits enrollment criteria for clients

Joined forces with EDI connections team to schedule and format EDI feeds from ADP to client’s carrier and back again on regular schedules

Transferred files, after Reliable Human Review, from one security classification level domain to another at the request of users

Streamlined scheduled file transfers, tracking ticket report by organization and user categories

Maintained system documentation and provided training to end users

Stayed up-to-date on relevant technologies and regulations

Illinois Back Institute, Wheaton, IL April 2016 to June 2016

Outcomes Analyst/Marketing

Analyzed and documented short-term and long-term health care data for current and former patients through online customer relationship management and internal electronic health records software platforms

Compiled data to better assist clinicians and administrative staff on improving long-term health of patients’ spines and overall quality of life

Developed and used indicators to help measure clinical outcomes, conducted medical record reviews and other data collection activities

Analyzed data abstracted from medical records and collected through other sources to identify compliance, trends, and performance improvements

Illinicare, Consulting Company, Naperville, IL February 2016 to March 2016

Provider Services Representative (Contract)

Developed expertise on various aspects of managed care plans

Interpreted UB04 and CMS 1500 forms for correct data, matching them with provider’s biographical information contained in various databases

Utilized knowledge of insurance claims and customer service to create strong relationships with the providers

Ensured provider service quality by making outbound calls to obtain data and verify information, as well as performing analysis and creating reports to clarify operational issues and opportunities.to-end provider claim and call quality, fostered positive relationships between the health plan, providers, and practice managers

Insight Global for Catamaran, Schaumburg, IL September 2015 to October 2015

Production Associate (Contract)

Set up robot jobs in RxClaim. Error analysis. Tracked the robot jobs

Environment: RxClaim, SQL, SharePoint, Snag-it, Outlook, Microsoft Excel, CMD window scripts

Two Point Conversions, Chicago, IL June 2015 to August 2015

Account Executive

Worked on converting purchased data from smaller pharmacies and converting them to work on larger chain pharmacies' systems prior to smaller chains acquisition by larger chain

Walgreen's Corp, Deerfield, IL August 2014 to April 2015

Non-Merchandise Supply Chain Analyst

Tracked, entered, and scheduled materials to be shipped for construction and set-up to new and existing stores

Acquired knowledge of construction terminology related to new store set-ups

Performed analysis of information, problems, and data, and made recommendations

Monitored, and measured the benefit of implemented solutions for complex issues, applying company policies and procedures in the resolution of a variety of issues

CVS Caremark, Consulting Company, Northbrook, IL March 2012 to May 2014

Enrollment Analyst/Claims Remediation

Set up and ported flat fie biographical patient data from a QL platform to RxClaim (AS400); researched and confirmed customer data with onsite QLEAs; analyzed flat files to ensure correct mapping of data when populating reports

Managed small team for remediation of outstanding Medicaid and Medicare pharmacy claims that were processed in error

Spherion Staffing, Lincolnshire, IL October 2011 to January 2012

Benefits Administrator CSA

Assisted UAW and CAT retiree and active employee populations in selected and enrolling in benefits plans

Coordinated with major health insurance providers to update eligibility and ensure proper documentation for each enrollee

Interpreted and applied benefit-related laws, regulations, and procedures; reviewing and examining evidence and making determinations as to the entitlement and / or eligibility of claimants for benefits and services involving compensation and pensions

LaSalle for Pi International, Rolling Meadows, IL June 2011 to August 2011

HCC Coder

Diagnostically coded and audited HCC records accurately and on time for submission to Medicare

Participated in HEDIS audit

Coded multiple areas of service and specialties; reviewed medical records and assigned appropriate codes, adhering to guidelines and regulations

Updated technical knowledge of legal and regulatory requirements

Marketsource, Inc. for IBM, Mettawa, IL January 2007 to April 2009

Bids Coordinator (Contract)

Contributed to high-end server bids

Expedited detailed processing of pricing to aid in quicker bid pricing turnaround

Organized multi-tasker, able to minimize errors in a fast-paced environment

EDUCATION AND PROFESSIONAL DEVELOPMENT

Augustana College, Rock Island, IL 1995 to 1999

Bachelors in Communications

American University, Washington, DC August 1997 to January 1998

Journalism

Certifications

Certificate in Health Information Management, College of DuPage, Glen Ellyn, IL, 2009 to 2010

CCA – need to renew (AHIMA), September 2010 to January 2014

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