Valerie A. Gore Phone: 301-***-****

***** ***** ***** ******* *****: adscmy@r.postjobfree.com

Germantown, MD 20874

Objective

Obtain a position as a team-player in a people-oriented organization where I can maximize my customer service experience in a challenging environment to achieve the corporate goals.

Qualifications

I have excellent customer service and people skills experience. Have working knowledge of MS Office suite, Microsoft Excel and PowerPoint. Ability to direct projects from concept to fully operational status. I am a goal-oriented individual with strong leadership capabilities. Organized, highly motivated, and detail-directed problem solver. Have the ability to work in unison with staff, volunteers, and board of directors. Also have able to work independently with creative thinking process. Work very well in a fast pace and under pressure. Communicate well in written and verbal format. Have basic Spanish knowledge.

Work Experience

Kaiser Permanente- Current

Sr. Configuration Analyst

Includes all responsibilities of the Configuration Analyst I and

Configures either Professional & Institutional Providers or Complex Benefits.

Leads business requirements development and solution design process including creation of requirements and design documentation and facilitating sessions with business owners and other team members).

Maintains detailed knowledge and understanding of the host Claims processing system rules relative to claims payment.

Coordinates, researches and resolves debarred and sanctioned provider data and ensures communication of required system updates to Provider Contracting and Claims Operations.

Conducts preliminary evaluation of contractual agreement prior to execution to determine system configurability.

Conducts systems requirement assessment in support of regulatory changes (e.g. ICD-10, ASC, DRG etc).

Analyzes business requirements to determine the best approach for configuration design, testing and implementation.

Analyzes benefit evidence of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits coverage.

Develops, documents and executes test plans for configuration testing and validates accuracy of data loaded.

Acts as the liaison between business configuration and business owners to ensure that all application and technical-oriented issues relating to the configuration requests/projects are appropriately addressed.

Writes/generates ad-hoc claims impact reports and compiles reconciliation statements.

Tests new version releases relative to system configuration and documents results.

Analyzes and make recommendations to management regarding system enhancements and communicates system problems and impact on operations.

Acts as the subject matter expert regarding Configuration Activities for cross-regional/national initiatives. Assists in establishing, and documenting policies and procedures in support of standardized and accurate configuration.

Validates design, testing and implementation of Configuration.

Provides coaching and mentoring to team members, workload distribution, tracking and workflow management.

Travels for team meetings up 25% of the time.

Contributes to SBAR (Situation, Background, Alternative, Recommendation) process.

Work Experience

CarMax- 11/2016- 06/2022

Lead Business Office Associate

Process and transfer vehicle title. Input vehicle appraisal information. Explain paperwork with customers and complete transaction in database. Process tags for customer. Answer incoming phone calls. Process checks refunds. Balance the cash drawers and close safe. Act as business office manager, answer customers and other manager questions. Train all employees on how to understand the processes and paperwork.

Education

Morgan State University 09/1981- 05/1986

Recruitment Assistant, Office Assistant

Assist the recruiting department in targeting high school students to attend Morgan State University though the sports and academic programs. Preform research on demographic of area of concern to reach potential students. Planed events with local sponsors for students once they arrive. Also assist in the admission office helping students with questions on their financial aid, payments and class requirements. Processing refunds and maintaining admission office by answering phones, filing and other duties as assign.

Computer Skills

•Microsoft Office

•Avid

•Final Cut Pro

•Excel

•Spreadsheet

•Powerpoint

Keyword Summary

I have proven ability to lead successful programs, great organization and time management skills and excellent presentation and communications skills.

References

Mark Roeder- 912-***-****

Supervisor, CarMax

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