Janina A Capellan-Stevens

Home: 860-***-**** Cell: 860-***-****

ad19l5@r.postjobfree.com

www.linkedin.com/in/janina-stevens-0b02b29/

Licenses

Connecticut State Casualty Adjuster’s Licensed

Medical Billing & Coding Certified

Pharmacy Technician Certificate

Bilingual (Spanish)

Efficient in Microsoft Products, Dynamics 365, Azure, Vantage, SQL, Subro Source, Quantim, Sunrise Record Manager, Tempus One Scheduler, Centricity, Amisys, Strata Ware, Ratchet X, Medicare/Medicaid Systems, SERFF, SharePoint, Salesforce, Confluence, Tableau, Jira, Amazon Workspace(AWS)

Sr. Regulatory Analyst

Oscar Healthcare January 2022 – Present

Project manage, implement, and improve processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements. Facilitate the approval and submissions of timely and accurate regulatory required reporting deliverables via SERFF, HIOS, CMS Tools.

Maintain filing information on departmental databases and SharePoint sites as a liaison to respond to questions and objections from state insurance departments, CMS and business partners. Update, create and support business requirements and policy administration systems for product filing changes communicating the results.

Research, tracking and other ad hoc tasks as needed. Plan Management Analyst

Access Health CT June 2021- December 2021

Perform quality assurance reviews as part of (QHP) certification/recertification process to ensure accurate, consistent documentation has been submitted by carriers via (SERFF) to include analyzing rates and benefits information.

Interpret (CMS) regulations and evaluate AHCT certification requirements to create business and system specifications, collaborating with IT for proposed user testing deployment timeframes. Manage and conduct functional, integrated and UAT testing for plan data and any new platform functionalities to include carrier data preview, rate data and security access credentialing. Determine impact assessment to existing IT system design, workflows, project milestones and system specifications.

Coordinate with Legal, Government Affairs and Operational leaders on Quality Improvement Initiatives. Quality Assurance Consultant

CT Paid Leave Authority/KForce August 2020- May 2021 (contract completed) Execute software test plans and maintain individual test cases documenting test results Work with various internal matrix partners for integrated testing and user support to ensure applications are fulfilling business requirements and are using internal standards of design and function Research and recreate reported production issues and document steps which may include User Acceptance Testing (UAT), Functional Testing, System Testing, Cross Browser/Cross Platform Testing, Mobile (iOS & Android) testing.

Communicate effectively with a wide range of audiences and situations, in a timely and professional manner which may include assisting with Client Interaction Responses within Omni Channel-Salesforce to expedite questions, comments or concerns

Quality Business Analyst

Global Atlantic Financial/ZeroChaos September 2018-September 2019 (contract completed) Responsible for monitoring and reviewing the quality and data of the New Business Resolution teams, and TPA’s within Retirement Operations implementing strategic business plans to achieve business goals Identify gaps and recommend enhancements related to services and workflows based on complete analyses and prepare written reports that summarize methodology and analysis using quality checklists while establishing procedural changes, updates and testing within Tableau, Excel, Confluence, Salesforce and/or SQL.

Coordinate with operational leaders on Quality Improvement Initiates which may include promoting, educating, and training.

Quality Review Business Analyst March 2017-September 2017 (contract completed) NEOSLLC

Work with operational leaders on Quality/Continuous Improvement Initiatives creating standard operating procedures for new requirements and provide recommendations on how to best display data in a report or dashboard within Salesforce, SQL or Excel.

Report and provide insight using web-based analytics and other data mining techniques such as SharePoint and Python to support the organization’s strategic plan to review, analyze and inspect insurance contracts.

Assess medical data for STD/LTD/Life to minimize disruption to benefits that are transitioning due to Renewal Rights Agreements. Maintain proposal and underwriting systems ensuring records are accurate and within compliance.

Provide the highest level of quality assurance to internal and external customer Medical Records Senior QA Specialist March 2013- January 2017 EXL Services

Analyze medical records, interpret documentation, and assign proper ICD-9/CPT/HCPS and Pharmacy codes.

Recovery for MVA claims for inpatient, outpatient facility and professional service Screen Medical Records for compliance with established company criteria and help designate exceptions or equivalents.

Validate overpayments of claims using client specific reimbursement policies and CMS criteria. Lead, train and develop team within the billing/claims unit. Collaborate with IT and Analytics teams assisting in test environments within multiple systems to validate current medical operational reports that may aid in driving application development. Implement solutions to develop, test, fix and review code in support of various applications to include programming languages such as SQL for internal and external customers and developers. Sr. Subrogation Specialist

EXL Services (promotion)

Investigate and pursue general liability property claim recoveries within company standards. Negotiate, deny, and authorize all subrogation claim payments. Provide training to new employees as needed.

Correspond with claimants, witnesses and attorneys to gather information to support claims. Prepare necessary state fillings within statutory limits including arbitration, rehabilitation, and litigation subrogation files.