Denise A. Konwinski

**** ********, ******* ** ***** (C) 734-***-**** (W) 313-***-****

Objective

To obtain a challenging position that takes advantage of my skills and corporate knowledge while collaborating with teammates and enhancing my knowledge within I.T.

Skills

Summary

Insightful and analytical individual with 8 years of experience in both an Operational and IT environment.

4+ years of experience with the NASCO Claims Processing System

3+ years of defining, building and refining the Workload Inventory model and the tool’s sub-components for Michigan Delivery Systems & Support (MDSS)

Knowledge of BCBSM Lines of Business and HealthCare Product offerings

Proven ability to take abstract ideas and convert them into viable solutions

History of demonstrating quality customer service, building respectful relationships, displaying innovation and creativity while communicating effectively with customers to ensure effective solutions

Takes responsibility and accountability for work outcome to ensure individual and team goals/objectives are met

Possess sound judgment and personal integrity, with demonstrated ability to develop solid working relationships

Ability to work independently and within a team with minimal direction

Well organized, self motivated individual with strong attention to detail

Extensive communication, organizational, and writing skills

Excellent ability to build rapport with vendors, customers, management and co-workers

Software

Proficient in Desktop Applications: MSOffice (SharePoint, MSP, Word, Excel, Access, PowerPoint)

Knowledgeable in MS Excel Formulas, Access VBA, SQL, Cold Fusion

Knowledgeable in NASCO Processing System modules to include Claims and Membership

Working knowledge of Project Management Methodologies

Employment & Experience

Databases and Software currently use in daily functions:

oLOCAL System - membership and claims data base for facility, professional, dental vision hearing BlueCard claim software knowledge for Home & Host claims processing.

oNASCO System - membership and claims database, BFM, BFAST, and BFA Projects direct. BlueCard claim software knowledge for Home claims processing. Extensive NASCO Systems Knowledge: can process claims in EEC, and do claims adjustment. Familiar with OBN, ODL, can send SIRFs and do claim adjustments for BlueCard program. Currently do the Par Plan implementation portion of the new business and validate and review claims that other BCBS Plans enter into the system to ensure that there are no edits and/or claims processing issues. Job functions ensuring that claim processing issues are resolved during policy implementations.

oCorporate software: CSR portal, including HCBO, Benefit Configuration, Inventory Manager (Change Manager), BFAST, duplicate EOBs for NASCO, BCR Inquiry, Adhoc forms, Medco and Med Access (Med Impact) claim databases.

oFamiliar with Microsoft Project software used by Project Management teams.

Work Experience

Blue Cross Blue Shield of Michigan

March 2013 - Present

Systems Analyst II– Enterprise Information Technology/BCR Unit

Responsible for planning, developing, testing and implementing IT system solutions that improve business efficiency and productivity as well as support business strategies and goals.

Identify and communicate business needs and translate business requirements into technical system and functional specifications.

Determine if internal or external solutions exist or whether new solutions are feasible

Map process flows to determine if solutions impact existing work processes and systems as well as ensure proper integration and testing, and system/user documentation.

Gather and analyze information to provide recommendations resolving business issues for a specific business group. Build relationships with peers and their team members to ensure objectives are achieved

Strategic Staffing Solutions (S3) contracted with Blue Cross Blue Shield of Michigan

May 2012- March 2013

Systems Analyst – MDSS NASCO/BCR Unit

Implementation of medical and/or payment policy for claims processing on the NASCO system.

Ensure that claim processing issues are resolved during implementation and 60 days review to determine implementation was successful.

Use BFAST functions and attended training

Implement all BCRs/projects accurately as possible as defined by the business requirements

Comply with Change Management

Ensure time is properly entered into all time tracking systems

Planning, coordinating, development and implementation of approved projects are in scope to improve overall efficiency of operational control, methods, procedures and performance.

Analyzing, reviewing and streamlining departmental process procedures and/or expediting operational transactions.

Respond to update/change requests following global work-drivers submitted through the BCR process:

-Legislative Rulings

-Recommendations made by the Joint Uniform Medical Policy (JUMP) Committee

-New Projects

-CARIT

-Association Mandates

-New Programs initiatives or modifications

-Existing product enhancements

-Project Maintenance

-Provider reimbursement

-Additions, deletions or modifications to certificates or riders (Not account specific)

-Annual and maintenance code updates (ICD-9, ICD-10, CPT, HCPCS, revenue codes)

-Claim Check/CXT version upgrades, customization

-Units/frequency/quantity/location/provider/adds or removals

-MOS Parallel Testing

-FEP

January 2011 – May 2012

Systems Analyst – MDSS NASCO/File Maintenance Unit

Maintain NASCO Provider and Pricing Files for all lines of business

Perform maintenance on NASCO and GENO Tables

Process NASCO Claim Flush requests

Create/update Online Desk Levels

Training and mentoring of new associates

Projects including SBP 12810 Portico to NASCO Interface for Professional lines of business, GENO Modernization and MESSA group integration.

Responsible for completing daily, weekly and monthly reports via Change Manager

NASCO claims knowledge

Recipient of 3 SPOT awards:

The SUPER Award

The 3 C’s Award

The Problem Solvers Award

The Bartech Group/ Ford Motor Company – National Employee Services Center

November 2008 – January 2011

Subject Matter Expert – Dependent Audit and Eligibility

Team content expert within Dependent Audit and Eligibility

Direct and coordinate the tasks of Personnel Benefit Representatives (PBR) assigned to the team

Asses team workload, available resources and prioritize team objectives

Support supervisor in achieving Call Center service level/documentation processing targets

Direct contact to research unresolved PBR issues

Determine eligibility and process enrollment changes of employees and dependents

Monitor email, mail, phone and faxed communications of employees inquiries

Obtain and review enrollee documentation and determine whether acceptable or unacceptable proof of eligibility

Follow-up with enrollees for additional documentation, if required

Process and direct appropriate forms and Health Care Applications

Interact with PBRs, PBR Specialists, Human Resource Business Operations and UAW Benefit Representatives to resolve issues and educate employees on Dependent Eligibility

Monitor and coach PBR's to ensure procedures and processes are being followed to foster delivery of consistent quality customer service

Provide solutions for escalated customer concerns

Assist in handling high priority calls and emails, and provide additional assistance to resolve issues with the objective to exceed customer expectations

Actively support the development training of new team members

Implement Flex open enrollment system updates and interim coverage for new hire employees

Record Sponsored dependent system updates

Assisted with data integrity system indicative data updates

July 2007 - November 2008

Personnel Benefit Representative – Dependent Audit and Eligibility

Provide dependent eligibility related information in response to internal/external inquiries regarding company benefit programs

Act on customer's behalf to resolve concerns and correct errors in accordance with company policies, procedures and guidelines

Obtain, review and process documentation received from customers.

Discern acceptable from unacceptable documentation and follow up with the customer as required in line with dependent eligibility guidelines

Accomplishments:

Implemented staff training on company systems, such as; NESC, PeopleSoft, Scopus, and HRIMS

Updated UAW Audit/Eligibility training material

Author of Q&A for Audit/Eligibility on HR-Online

Selected to represent department on several committees aimed to develop and foster process improvements

Developed, published and implemented process improvements within multiple departments

Woodhaven/Brownstown School District

2005-2007

Paraprofessional

Assist students and staff in all facets of curriculum

Assigned to Media Center to function as librarian on long term assignment

Given the honor and privilege to work with special needs students

Additional Skills:

Strong project management skills

Proficient with Microsoft Excel, Microsoft Access, Microsoft Project, Microsoft Word

Typing 50+ WPM

Education

1995-1999Associates Degree, Henry Ford Community College

Dearborn Michigan

Concentration in nursing

June 1987 Huron High School

New Boston, Michigan

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