Customer Service Project Manager

Deanne N. Bernard

Certified Tapestry Analyst - Kaiser Permanente

Fayetteville, GA

*************@*******.*** - 678-***-****

WORK EXPERIENCE

Certified Tapestry Analyst- (WFH Consulting)

Kaiser Permanente - Englewood, CO - May 2014 to Present

•Provide consulting services for the Epic Service line, including system design, system build, system

configuration, validation, and testing for Tapestry AP Claims Contracts, Utilization Management and Benefits

Engine.

•Configuration Analyst Utilization Management Case Management.

•Designed and built new standard and non-standard benefit plans, reviewed and analyzed benefit summaries;

and identified best approach to code/develop benefits to achieve optimum adjudication levels.

•Built, tested, implemented and maintained Epic's benefits engine system including, but not limited to,

components, component groups, adjudication tables/formulas and benefit packages in order to accurately

estimate patient financial responsibility and standard authorization/precertification requirements.

•Built Tapestry EDI claims for the client. Provided support for Tapestry AP claim, vendor contract and provider

build as well as Epic foundation.

Certified Epic Benefits Engine Tapestry Analyst (Consultant)

Group Health Cooperative - Madison, WI - August 2013 to January 2014

Provided support for GHC current benefit process

• Reviewed 2014 Health exchange new benefits that GHC offered and built benefits base on 2013 package

templates for different products. I.E. HMO, PPO, Metal Plans and HSA

• Provided build within the following master files: components, component groups, adjudication tables,

adjudication formulas, benefit variables, benefit buckets, etc.

• Designed and built new standard and non-standard benefit plans, reviewed and analyzed benefit summaries;

and identified best approach to code/develop benefits to achieve optimum adjudication levels

• Gathered and documented data mapping rules, business rules and business requirements to support ICD-10

code translation.

• Developed strategies to change GHC benefit buckets from calendar year to contract year without affecting

current CMK and EPP

• Created new benefit buckets, adjudication tables and formulas to be built in order for benefits and claims

to adjudicate accurately

• Performed configuration activities in one or more of the following areas: institutional and provider contracts,

benefits, authorizations, and/or general configuration, such as system edit rules, fee schedule updates, etc. that

support claims processing consistent with the provider contractual arrangements and according to a group's

evidence of coverage (EOC)

• Served as a link between business users and IT technical support team

• Analyzed benefit explanation of coverage to determine best approach for loading benefits offered, including

co-pays, out-of-pocket maximums and state/regulatory benefits, etc.

• Created spreadsheets for GHC to house current and new CMK (package), CML, CMA, PPG, EPP, etc. for

tracking purpose

• Tested build through claims after benefit/master files build, to make sure claims adjudicated correctly

• Prepared training materials and communication updates and conducted training

Certified Lead Epic Tapestry Analyst (Consultant)

John Muir Hospital - Walnut Creek, CA - January 2013 to July 2013

Performed full life cycle - implementation, design, build and test of Epic Tapestry applications (which includes

design, build, test and go-live)

• Provided all build, testing, and support for CRMs, capitation, eligibility, Resolute, referrals, AP claims, MyChart

and Planlink

• Prepared builds in POC, tested in TST for implementation to flow into production

• Facilitated and led meetings to educate end users of the features of Epic before the build phase

• Consulted with clients, researching and troubleshooting issues to understand software build steps needed

for production environment of business application

• Designed, developed and implemented new and improved processes, tools and system enhancements

• Tested application configurations and builds and performed unit testing in non-production environments and

reports on outcomes testing.

• Provided analytical support to help identify systemic risks and opportunities resulting from the many-to-many

ICD-10 mapping and rule definition efforts.

• Reviewed testing strategies for appropriateness to test the build or configurations to determine if they are

ready for implementation

• Assisted implementation team in the requirements gathering stage by documenting current state and

workflows as well as other documents as assigned

• Performed project management activities in the development and implementation of systems changes.

• Performed Revenue Cycle remediation for an ICD10 project.

• Worked collaboratively with end users, application analysts, and other IT staff to develop a solution that

meets business requirements

• Responsible for analyzing business requirements, workflows and application capabilities

• Responsible for the daily configuration maintenance within the Configuration Information Management (CIM)

Team

• Utilized Epic userweb daily

• Submitted Sherlock tickets when application issues arise and research any build, testing issues through

Galaxy

Certified Epic Benefits Engine System Analyst

Kaiser Permanente - Atlanta, GA - September 2007 to January 2013

Built, tested, implemented and maintained Epic's benefits engine system including, but not limited to,

components, component groups, adjudication tables/formulas and benefit packages in order to accurately

estimate patient financial responsibility and standard authorization/precertification requirements

• Analyzed, interpreted and built benefits in the benefits engine according to GCF and Kaiser Permanente

assumptions to support Resolute Professional Billing and Tapestry AP claims

• Assured that all systems are fully tested before implementation into production

• Troubleshot and resolved reported system and application problems in the test and production environments

• Supported the successful identification, analysis, build, testing, training, and implementation of benefit engine

areas

• Designed and built new standard and non-standard benefit plans, reviews and analyze benefit summaries

• Built system to support the new workflow.

• Met deadlines, prioritizes appropriately, copes well with change, and maintains composure under pressure.

• Developed desktop manual for benefit configurations and employer group benefits loading

• Trained new benefits system analysts on new procedures and processes

• Created standard operating procedures for new and existing features

• Reviewed and analyzed application system including testing, debugging, and installing

• Ensured the provider, authorization and benefit configuration meets established business rules and

procedures

• Performed intermediate analysis/support using databases and data reporting tools

• Developed the process and approach for conducting the mapping for the remaining ICD-10 diagnosis and

procedure codes expected for the Kaiser Permanente

• Worked with clinicians, business analyst and project manager to establish credibility at all levels within build

problem-solving partnerships

• Validated and adjusted co-pays, coinsurances and deductibles for correct Resolute Professional Billing and

Tapestry claims adjudication

Social Service Coordinator, Miami Lakes, Florida

Supervisor: November 2003 - April 2007

• Managed department's activity of conducting telephonic outreach activities to review and assess M+C plan

member's eligibility for Medicare Savings Programs (MSP)

• Provided the intakes instruction and feedback on the necessary steps to pre-qualify M+C plan members for

an MSP

• Managed the process of meeting department's daily, weekly and monthly production goals

• Managed the monthly conversion percentages of total caseload converting from queue to potentially eligible,

outbound contacts to outbound interviews, inbound contacts to inbound interviews

• Maintained department's proper percentage of caseload dispositions (i.e., not-interested)

• Oversaw department's Medicare Outreach activity (i.e., assigned's, PEs, over income, over assets, etc.) and

conducted analysis, tracking and reporting on this activity

• Managed department's caseload of assigned member files

• Oversaw that quality standards are being met by monitoring the department's employees for proper

phone etiquette and adherence to scripts; ensured accurate and descriptive MMS documentation and proper

disposition of cases

• Led, motivated, developed and coached department's associates on performing at optimal production levels

at all times

• Participated in the development and administration of Intake services and provided feedback for operational

and continuous improvement for the department

• Provided the overview, analytical, and data management reports supporting the operational aspects for intake

services

• Conducted training and oversight of the intake operations including, but not limited to, performance

evaluations, direction, case management assignment and intervention, reporting and discipline

• Maintained current knowledge of state and federal regulatory requirements to adhere strict compliance of all

aspects of social services coordinator's outreach operations

• Demonstrated behaviors, actions, and attitude that reflected social services coordinator's vision, mission and

values

Senior Claims Analyst II

United Health Group - City of Sunrise, FL - July 2001 to November 2003

Communicated with members or their authorized representative(s), regarding the health plan's response and

grievance/ complaint process

• Assessed high dollar claims for payments

• Coordinated and monitored all aspects of claims processing for designated line(s) of business as assigned

• Educated providers, customers, and members on health plan benefits and services

• Processed and adjudicated health claims according to contract along with web UB92 and HCFA claim

submitted forms

• Provided timely customer service to members, providers, billing departments and other insurance companies

on the subject of claims

EDUCATION

High School Diploma

Cornerstone

CERTIFICATIONS

Epic Benefits Engine Basics and Health Plan

Benefits Engine makes it easy to handle copays, co-insurance deductibles, maximum out of pocket limits,

tiered benefits and more - allowing users to make informed decisions and minimize errors.

Epic Benefit Engine AP Claims

A comprehensive Benefits Engine makes it easy to handle copays, co-insurance deductibles, maximum out

of pocket limits, tiered benefits and more - allowing users to make informed decisions and minimize errors.

Epic Tapestry Core

Tapestry is a comprehensive, flexible system designed to help health plans manage operations across all

lines of business. It gives payor organizations the tools necessary to meet the needs of members, employers,

affiliates and the providers that serve them. Tapestry automates eligibility tracking, premium billing, utilization

management and contracting/claims operations using sophisticated benefit plans and contracts. It also works

seamlessly with Epic's clinical, financial and access applications wherever they are implemented in your

affiliated delivery networks.

ADDITIONAL INFORMATION

Deanne is a certified Epic System Analyst with thirteen years of experience in healthcare. She has worked with

Epic software for seven years, and have a firm grasp on the integration points within Epic. She has a strong

knowledge of Epic/Tapestry, Benefits Engine, Referrals, Planlink (Provider Portal), Common Membership,

Resolute, Cadence and Prelude. Deanne has worked with HIPAA, federal, state and local regulations relating

to privacy, confidentiality, security and CMS. She has a strong knowledge of CPT-4, ICD-9 and ICD-10 coding

with medical terminology. Deanne has excellent understanding of the back-end revenue cycle processes. Skills

and experience includes; Building, testing, go live and project management.

Performed two full cycle ICD-10 implementations and three conversions.

Deanne has perfomed to full cycle EPIC go live and end-users support.

Facilitated leadership and EPIC training to new and existing employees.

Very knowledgable with Visio and work flows.

Managed multiple tasks/projects simultaneously in a fast-paced environment under intense deadlines.

Served as lead subject matter expert (SME) on team for refund recovery payments issue.

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