Marilyn Thomas

Yeadon, PA *****

acy0gi@r.postjobfree.com - 610-***-****

WORK EXPERIENCE

Systems Analyst - Applications System Management

Health Partners Plans - Philadelphia, PA - August 2014 to December 2016 Used Agile Project Life Cycle methodology to ensure successful project conclusions by meeting department and corporate objectives. Performed analysis of processes, procedures and practices, in department or an assigned area, identified and made recommendations for improvement. Developed and implemented business system solutions to meet customer needs and requirements, including project designs, success measurement, testing, auditing and documentation. Identified alternative solutions and resulting outcomes when needed. Independently managed the completion of projects ensuring priorities and meeting timelines.

Served as an Information Services liaison with external vendors, business process owners and management to modify and design procedures and reports. Supported system conversion and upgrades, contributed to the development of implementation plan. Deployed, migrated documents and provided support to facilitate system implementations.

Understood the chain of command, points of accountability and decisions for specific matters and communicated accordingly. Decisions were consistent with established programs and management policies, procedures, protocols and goals.

Developed test plans, quality assurance and audited procedures for new systems or system enhancements. Ensured deadlines for review and reporting responsibilities were met. Was responsible for the delivery and coordination of training for Business Analysts and Business Units. Anticipated and kept project staff, stakeholders and management staff informed of future or planned events which would impact an implementation.

Contract Specialist

Health Partners Plans - Philadelphia, PA - June 2009 to August 2014 Developed and maintained cost effective provider networks for all assigned lines of business. On an on-going basis, reviewed adequacy and accessibility of assigned provider networks. For assigned providers, prepared contracts, contract amendments and rate analyses. Recommended rate proposals, participated in rate and language negotiations and recommended language for contract changes. Worked with other departments to implement new contracts, and changes to existing contracts were both accurate and on a timely basis. Ensured contract effective dates were properly assigned to facilitate timely contract approvals and implementations. Notified and described contract changes to other departments and interpret provider agreements.

Calculated scheduled rate increases, obtained provider concurrence and implemented changes with other departments. Led provider termination work groups as assigned by manager, including identification of operational issues unique to each Termination or provider type. Recruited providers into Health Partners network advancing membership recommending pricing, analyzing proposals, negotiated and contracted new providers. Recommended necessary operational changes to appropriate stakeholders (e.g. pre-certification requirements, system set-up) as required. Facilitated modifications to database and other Health Partners operations as indicated in accordance to the contract. Acted as a liaison to provider for contracting resources and inquiries. Served as departmental representative on interdepartmental and external work group forces relative to provider networks and contracting information

Other Assigned Duties:

Worked as the Project Manager for the implementation of the new credentialing and contracting software IntelliCred/IntelliContract for the Network Management Department. Responsible for automating the contract management system with an automated workflow that integrated with the credentialing system. Followed through with each of the task for software deployment. Successfully managed the project plan and timeline through weekly internal and external meetings. Developed and maintained relationships with project team members, vendor and client areas as appropriate. Provided support to development and implementation on an on-going basis.

Organized clear functional requirements to be mapped to cater to Network Management by developing a functional search screen design to define the feature-functions of IntelliContract and to meet business requirements. Conducted ongoing User Acceptance Testing (UAT). Diligently worked with Intellisoft to resolve issues in time for implementation.

Coordinated the logistics training for both IntelliCred and IntelliContract sessions by organizing the training rooms, equipment and materials necessary for the training programs. Physician Network Consultant

Health Partners Plans - Philadelphia, PA - May 2008 to June 2009 Partnered with new providers facilitating presentations and education designed to orient them to Health Partners network. Served as advocate for Health Partners' membership ensuring provider meets contract terms. Acted as a resource to Provider relative to contract inquiries. Researched and troubleshot member complaints within 24 hours to ensure provider services are delivered with dignity and respect. Reviewed provider's application to ensure Health Partners' standards for credentialing were met. Worked closely with provider securing required documents to initiate the credentialing process Served as point of provider contact from time of application to post-credentialing process. Collaborated with the credentialing department staff for timely completion of site evaluations and communication of provider site issues as they relate to recruitment.

Increased network participation by building relationships with and recruiting providers into the Health Partners network. Maintained database and spreadsheets to track and trend recruitment monitoring activities, results and outcomes. Pro- actively monitored and identified new industry trends to gain organizational consensus on a course of action regarding future contracting strategies. Organized and attended quarterly meetings with a variety of client groups ranging from large teaching hospitals to small community hospitals to individual providers. Reviewed issues related to claims, provider profiles, capitation, billing, incentives and payment to ensure client satisfaction. Tracked and trended provider concerns and issues, worked with internal customers to research and propose resolution, documented outcomes, and provided progress reports to clients and provided progress to clients and Health Partners management.

Provider Relations Representative (SEPA)

HealthAmerica/HealthAssurance - Plymouth Meeting, PA - December 2006 to May 2008 Provided exceptional customer service by supporting the Claims team and responding to inquiries from providers. Answered provider inquiries regarding verification of benefits and claims status for medical claims. Recruited and credentialed new providers according to Pennsylvania state law, NCQA and HealthAmerica's standards.

Field Network Coordinator

Magellan Health Services - Philadelphia, PA - August 2005 to November 2006 Provided exceptional customer service by supporting the Claims team and responding to inquiries from providers. Answered provider inquiries regarding verification of benefits and claims status for medical claims. Recruited and credentialed new providers according to Pennsylvania state law, NCQA and Magellan's standards.

Learning Specialist/Trainer II

Independence Blue Cross - Philadelphia, PA - July 2001 to August 2005 Led learning and development initiatives to advance operations and revenue. Taught Managed Healthcare Systems (MHS) navigation classes for new hires with the objective of learning how to properly process IBX claims. Provided direction regarding entry level claims skills and procedures for the commercial lines of businesses. Developed continuing education

curriculum including guides for faculty and participants, lesson plans, new educational assessments and evaluation tools.

Supervised and mentored newly hired claims employees and Level I Trainers. Coached and counseled Trainer I talent in development of commercial lines of business theory and claims processing skills on MHS. Assisted hiring managers with post orientation support for claims processing education of new hires. EDUCATION

Bachelors of Sciences in Public Health

West Chester University - West Chester, PA

1998

Associates of Sciences in Respiratory Care

Gannon University - Erie, PA

1996

Associates of Science in Liberal Arts

Community College of Philadelphia - Philadelphia, PA 1993

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