Data Analyst Customer Service
Resume:
Tawanda Johnson
******************@*****.***
Tampa, FL
OBJECTIVE
Commitment to process improvement, reporting and increasing efficiency. I am seeking a new role where I can assist in developing and nurturing a dynamic team, with emphasis on accountability, maintaining compliance, and meeting core metrics. Proven ability to find solutions to complex issues to create barriers and create optimal customer service experience. Experience collaborating with internal and external business partners, resolving claim issues.
SKILLS
● 16 Years of Corporate Operations
● 13 Years Health Insurance experience
● 3 Years Configuration Data Analyst
● Methodologies
● ICD9, ICD10, CPT, DRG, APC
● Microsoft Office
● Word
● Excel
● Expert user of Perot Data System
environments
● Medicare and Medicaid Claims
● PHI and HIPAA HITECH Compliance
● Business Continuous Improvement (CI),
● LEAN principles
● Collaboration on Cross-Functional team
projects
● Soft skills: Exceptional Organizational,
Verbal & Written Communication
● PowerPoint
● SharePoint
● Microsoft Teams
PROFESSIONAL EXPERIENCE
Provider Data Analyst, Centene March 2019 to December 2023 Duties:
● Participated on cross-functional teams from Operations,
● Product Development, Network Management, Care Management and Technology teams to define and develop data deliverables and develop solutions that are scalable and reusable across the organization.
● Led data design activities based on approved business requirements.
● Made recommendations for business process improvement for any department procedures and systems architecture.
● Prepare and review documentation from data extracts and prepare strategies for overall delivery of provider network data activities, analyzing, reviewing, forecast, and trend complex data as requested and prioritized by the business.
● Participate in test case development and test execution activities and provide continued collaboration through project network implementation and maintenance schedules.
● Maintain accurate records and capture progress of projects using shared Gannt chart software.
● Providing effective communication by preparing written reports and also providing oral summary of recommendations to the Leadership team and stakeholders for the purpose of review and sign off.
Claims Analyst II, WellCare, March 2015-March 2019 Duties:
● Claims adjustments, complex pricing issues including High Dollar Claims audits, provider business correspondence, provider education, resolving member and provider disputes, performing root cause analysis of Complaints Tracking Module (CTM) escalations, resolve vendor fee schedule disputes, troubleshooting technical system problems, participate in business continuous improvement focus groups, helping to develop high performing teams. Mortgage Loan Processor, Bank of America February 2014-January 2015 Duties:
● Home Equity Loan Fulfillment by initiating and maintaining contact with members, monitored loans, took appropriate actions on identified deviations to ensure members received timely service.
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