Data Entry

SHEILA L. HOLMES 610-***-****

***************@*****.*** https://www.linkedin.com/in/sheilalholmes/

Bethlehem, PA 18020 (Lehigh Valley)

PROFESSIONAL SUMMARY

oAccomplished Business Systems Analyst with 13 years broad health and 3 years life insurer experience and working knowledge of IS Systems Deveopment Life Cycle, business requirements planning and execution and Waterfall/Agile methodologies

oExpert in resolution of Member, Provider, Group and Executive inquiries related to complaints received from multi-state departments of insurance, elected officials, Better Business Bureau

oFormer workgroup lead in compliance implementations of Benefit Language claims systems coding, focused on claims payment policy application and interpretation for claims systems development including CPT-4, ICD-9 (10), and HCPCS coding conventions

oExperienced in claims payment policy application and interpretation for claims systems developmen to include CPT-4, ICD-9 (10), and HCPCS coding conventions

EXPERIENCE

Reliance Standard Life Insurance

IS Business Systems Analyst II 2015 to Present

Collaborate with Senior Business Application Owners (BAOs), Subject Matter Experts (SMEs) and external vendors to document system setup and requirement changes for life insurer systems

Project: Annuities Commission Payments Application Platform Change

Work with BAOs, SMEs, and vendors to develop and install new application for Annuities business, including Agent Commissions payments processing. Gather and document requirements related to New and Conversion of existing business. Triage User Acceptance Testing error reports pre-and post-production install. Create/maintain Functional Access .xlsx from development through production handoff

Project: Business Requirements Academy

Worked with global senior management in company-wide effort to gather and document development of Business Requirements training; performed User quality review of web-based interactive training content

Project Document Management System Application Platform Change

Create and apply Business Requirement Management Planning templates and documentation based off of RFP for project -to include all forms of business requirements documents, modeling, data mapping, and tracking in preparation for project from development through implementation

AmeriHealth Caritas

Corp Contracting & Provider Networks (CPN) Analyst 2013 to 2015

oRepresented CPN within Project Management Organization workgroup as a SME between Account Executive Provider Network Outreach team, Credentialing, Medical Economics, claims Configuration, Information Services, Corporate Communication, Information Document Systems, Executive Management contracts signature execution, and Purchasing

oCoordinated and maintained new provider data of dual eligible markets for hand-off to local plan

oEnsured data was accurately updated in multiple systems (Access, SharePoint, network drives, Contract Manager, Facets) by performing audits of Coordinator data entry and by assigning audit tasks, recurring work, and data intake requests

oPerformed gap analyses between data bases to initiate configuration changes and maintain data integrity

oReviewed, revised, and wrote process policies, standard operating procedures, work instructions, and capture detail of individual market segment implementation for historical purposes

oCreated detailed reports for workgroup to deliver all data within various Credentialing stages

oEnsured data compliance by reviewing and scrubbing as necessary, data received from regulatory sources (OIG Exclusions, CMS error submission reports)

oInitiated and submitted requisition for mass mailings (letters of intent; contracts, credentialing requirements) to anticipated provider network

Independence Blue Cross

Medical Policy & Technical Evaluation Business Systems Analyst 2008 to 2013

oSuccessfully led implementation workgroup consisting of 63 SMEs representing 27 departments to effect systems changes when benefit language contract (BLC) changes approved by respective state Depts. of Ins (Pa, NJ, De.) by performing gap analyses between systems logic and member contract language.

oTracked, investigated and responded to post-implementation inquiries to ensure disconnects successfully identified and resolved, including key deliverables, ownership, scope, timelines, decisions, documents (requirements management,) contacts, workflows, and risks related to 170 BLC topics over ten years.

oSharePoint Admin: Developed data management site to maintain documents, decisions, tasks, contacts, workflows, projects and application architecture logic to streamline Workgroup activities according to specific workgroup and departmental needs (transparency, work effort, and inquiries research)

Managed Care Rules Business Systems Analyst 2007 to 2008

oInteracted with various intra- and extra-departmental areas to research, analyze, and develop policy documents in accordance with managed care rule processes and procedures such as: Medical and Claim Payment Policy, Procedure Code Review; Clinical Policy; Implementation and Analysis; Communications, and external departments consisting of Systems Coding; Communications; Product Management; Medical Directors; Appeals and Grievances; Care Management and Coordination

oParticipated in Benefit Language Clarification implementation workgroups to ensure language changes communicated from various departments of insurance are systematically enforced

oResponsible for Microsoft SharePoint site creation, administration, and maintenance

Corporate and Public Affairs Executive Inquiries Specialist 2005 to 2007

oProvided professional, expeditious, accurate, and courteous responses to all subscriber, provider, and facility-related inquiries directed to President, Exec staff, and Sr Management of IBC and subsidiaries

oInvestigated and responded to all inquiries from members of the IBC Board of Directors, Federal, State and City Governmental Officials, including various regulatory and health oversight agencies, such as state insurance departments and offices of attorney general

AmeriHealth Member Service and Correspondence Rep 2003 to 2005

oResponded to group, member, provider, and third-party inquiries regarding all aspects of claims and benefits

oEnsured company HIPAA compliance by verifying requests for PHI and performing database entries

EDUCATION

Systems: Lotus Notes; Microsoft (Word, Excel, Access, PowerPoint, SharePoint); Life Ins (FAST, PACS); Health Ins Claims (Facets, PowerMHS, Legacy PPO (Oscar/pfelix); Adobe Photoshop/Illustrator; Mariner (Time/Project Tracking from Requirements through Production)

Learning Tree International: Business Analysis Introduction: Defining Successful Projects 2017

Albuquerque Technical Vocational School 1998 to 2000

HTML, MS Word, Excel, Access, PowerPoint, Project, Adobe Photoshop, Illustrator, PageMaker

United States Air Force

Senior Airman, Photographic Technician, Kirtland AFB 1994 to 1996

Airman 1st Class; Linguist USAF Defense Language Institute 1992 to 1994

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