Project Manager Business Analyst

Welton L hall

********@*******.*** I 301-***-**** I WELTONHALL/LINKEDIN

Master Project manager

Healthcare Claims Management Resolution • 20 Years in Progressive Roles with Large Hospitals and Insurers • Financial Responsibility to $300M

Financial Planning & Management Analysis Budget Development and Management

Quality Improvement Processes Policy Development & Contract Administration

Provider Relations & Negotiations Contract and Compliance Regulations

Inventory Planning & Control Employee Training, Development & Leadership

Resource Management and Mentoring Scope Management and Change Management

professional experience

Mission Consulting Services 2021–2022

Business Operations Manager (VACO), Washington, DC July 12, 2021–May 26,2022

Accountable for managing solution development roadmap and release planning, coordinate with requirements lifecycle workstream to continuously assess against solution development plan. Notable:

Support the Department of Veterans Affairs (VA) Electronic Health Record Modernization (EHRM) program as a Revenue Cycle Project Manager.

Conduct cross-functional action team activities, provide support to adoption, incident management, and coaching opportunities.

Support site deployment analysis of incidents related to Business Operations and Revenue Cycle solutions and identify trends and root causes.

Develop recommendations for resolution and ensure functional validation of burndown and closeout.

Support development of communications to functional communities.

Anthem/Amerigroup 2015–2021

Business Analyst II (MD Medicaid MCO), Hanover, MD September 28, 2015–July 7, 2021

Accountable for researching, analyzing, documenting, and coordinating the resolution of escalated and/or complex claims issues that span across multiple operational areas and requires expert knowledge of all systems, tools and processes. Provide recommendations to senior management on solutions. Notable:

Provide team leadership including oral and written updates to senior management fr team representation at internal and external meetings with network physicians and hospitals and coordinated the identification and resolution of root causes involving configuration, claims and/or contracting activities.

Coordinate and develop programs for the resolution of claims issues through implementation with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.

Facilitates in the review of state or federal complaints related to healthcare programs or claims.

Executes claims and trend analysis to ensure healthcare quality goals are within company guidelines, obtains necessary approvals to close out claim issues.

Medstar Georgetown Hospital 2013-2015

Billing Analyst (Transplant Institute), Washington, DC December 29, 2014 –September 25, 2015

Insurance Analyst (Physician Billing), Arlington, VA May 6, 2013 – December 26, 2014

Accountable for processing all billing functions for assigned areas Follows up on all insurance including credit balances; Follows up on denials; Sends tracer letters for claims; Responds to telephone or written inquiries. Research aged receivables for problems and makes required adjustments for approval; Prepares weekly billing status report.

Maintains accurate financial records for accounts payable and accounts receivable. Accountable for the duties related to the daily capture and review of all chargeable items.

Serves as a resource to fiscal management and other administrative staff by assisting in the development/implementation of cost-effective policies and procedures for the department including bookkeeping, data processing, and auditing.

Processes and reviews all accounts for billing (both electronically and / hard copy). Processes for collection of all delinquent accounts.

Reviews accounts receivable aging monthly for designation of write offs and adjustments and status of accounts.

United Healthcare 2012

Provider Relations Advocate Manager (DC Medicaid MCO), Washington, DC March 5 – November 7, 2012

Directed the full range of provider relations and service interactions, including working on end-to-end provider claim, prescription drug services and call quality, ease of use of physician portal and future service enhancements, and training and development of external provider education programs. Notable achievements:

Lead cross organizational teams tasked with coordinating the departments to contract providers onto the network for Behavioral Health promoting Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program for a D.C. Medicaid MCO.

Accountable for facilitating and leading issue resolution processes and working in collaboration with National Claims Administration/Provider Systems Administration shared services team. Empower ideal and precise setup of agreements in claims frameworks.

Kaiser Permanente 2004 - 2011

Lead Analyst (HMO), Washington, DC January 3, 2010 – July 7, 2011

System Support Analyst (CSSO), Silver Spring, MD January 1, 2006 – January 2, 2010

Senior Claims Resource Processor (CSSO), Silver Spring, MD March 1, 2004 – December 31, 2005

Carday Associates 1993–2004

Claims Supervisor (TPA), Beltsville, MD January 1, 1996–September 18, 2004

Assistant Supervisor, Shop Steward, New Carrollton, MD June 28, 1993–December 31, 1995

education

Bachelor of Arts • University of Maryland University Center, College Park, MD

Database Management • Strayer University, Camp Springs, MD

technology skills

•AAPM ® MPM ® Master Project Manager® Health Insurance Sales License (MD & VA)

•Proficient in Project, Access, PowerPoint, Visio, Excel, Word, Citrix, Outlook, Lotus Notes, Next Gen, Heartbeat, Facets, TOAD, MySQL, Crystal Reports, Adobe, Lotus 1-2-3, Quicken, and Macess.

•Automotive Mechanic

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