Enrollment Specialist Data Analyst

Denise M. Forsythe Managed Healthcare Operations Professional.

adw4zf@r.postjobfree.com 215-***-**** Philadelphia, PA 19138 Skilled healthcare operations analyst with network management, provider relations. credentialing, and claims data experience.

Areas of Expertise include:

Network Management Data Analysis

Provider Recruiting and Contracting Critical Analysis and Troubleshooting

Credentialing Banking/Accounting

Claims and Billing Resolution Utilization Trend Identification Professional Experience

First National Bank of Maryland • Easton, MD • 1992 to 1994 Senior Bank Teller (Full-Time)

Handled transactions for customers including check cashing, deposits, withdrawals, transfers, loan payments, wire transfer, cashier’s checks, and opening and closing of accounts..

● Reconcile cash drawers at the end of the shift, count and package coins and currency, turn in any excess or damaged currency.

● Keep customer’s' bank information, and other documentation secure and up-to-date. Centerville National Bank • Centerville, MD • 1994 to 1997 Bookkeeping (Full-Time)

Review daily treasury reports and ensure accuracy of all data inputs, transactions processed, and journal entries posted as needed.

● Review prepared daily cash position summaries and elevate significant cash variances.

● Build awareness of new products and services, and identify customers' needs to capitalize on the business referral opportunities.

Independence Blue Cross (1998 to Present) • Philadelphia, PA • 1998 to Present Provider Data Analyst•2005 to Present

Resolve healthcare provider issues related to the Blue Cross integrated delivery systems in the Mid-Atlantic States. Service multiple providers, including primary care providers, medical specialists, hospitals, and ancillary providers. Evaluate new and current providers and maintain network credentialing files, updating monthly with physician licenses and insurance information. Facilitate resolution of internal and external questions on claims payment, provider data, and demographics. Foster good working relationships with participating providers while delivering corrective messages, as needed.

● Work to consistently improve and streamline systems and processes.

● Facilitate team meetings on credentialing and network management topics. Enrollment Specialist•2002 to 2005

Processed Personal Choice and Keystone Health Plan East products, reviewed submitted enrollment requests and quantitative and qualitative information, and triaged for discrepancies and incomplete information for referral to the enrollment outreach team. Facilitated work teams and coached new employees to improve work quality and productivity. Conducted systems review and analysis to troubleshoot claim problems and notified management of potential billing or benefit issues.

● Collaborated with company subject matter experts, corporate clients, and vendors to resolve problems. Claim Process Analyst•1998 to 2002

Analyzed discrepancies in claims and provider data to support resolution and identify trends that would require longer term solutions. Studied claims utilization data to identify areas of over-utilization or abuse and the potential for cost reduction. Reviewed provider data to identify gaps in services.

● Reported observed trends of continuous claim errors or processing problems for corrective interventions.

Education

Associates Degree, Technology,

Community College of Philadelphia • Philadelphia, PA Certificates & Licenses

Phlebotomy Technician Training Certification, PathWays PA Certified Nursing Assistant (CNA), American Red Cross Training & Development

Proficient in data systems/skills: CPR, DOH, JCAHO, ACGME, CACTUS, OSCAR, NAVINET Volunteer Experience

Independence Blue Crew, Ronald McDonald House, United Way, and March of Dimes.

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