Managed Care Customer Service
Resume:
CHIMAN KO
Valrico, FL *3594
adzx75@r.postjobfree.com
Professional Experience:
WellCare Health Plans / Centene Tampa, FL
Senior Business Analyst/Operations/Health Services 7/2012 – Current
Automatic provider exclusion verifications via Death Master File, OIG, SAM.GOV and NPPES for initial and recredential providers.
Co-creation and UAT of company wide Exclusion List Check scripting to verify internal and external customers.
Developed monthly market TAT reporting for the state of Kentucky.
SAS Enterprise Guide reporting for Xcelys, OmniFlow, Cactus and Oracle databases.
SAS report automation via email.
AutoHotKey macro scripts to automate repetitive tasks in any Windows environment.
Analyzed the quality of the output from analytical report and discussed with business user for solutions to improve data quality.
Performed data quality, data integrity and data availability by using SAS EG as to ensure data converted from the source database into target system exactly follow the business requirement.
Output Delivery System (ODS) facility to write analytical reports directing SAS output to format files which includes statistical results tables, analysis summary, and data interpretation.
Import any format data into SAS and established Enhanced Entity Relationship (EER) diagram to build relational database model.
Import, validate and scrub large datasets and use PROC functions to join tables.
Highly skilled in data manipulation and generating customized reports with SAS data steps and procedures and have extensive experience in handle large amounts of data for data cleansing, data profiling and data scrubbing.
Hands on experience in SAS programming, merging SAS data sets, developing SAS procedures, macros, preparing data, producing reports, SAS formats, SAS functions, SAS informats, storing and managing data in SAS files.
Expert in creating new macros and updating existing macros for daily, weekly and monthly report.
Extensively worked with business partners, statisticians, and key stakeholders to provide SAS programming for analyzing data as well as generating reports, tables and listings.
Ability to work on multiple tasks and strong interpersonal, analytical and presentation skills.
Excellent in analytical, presentation, communication and problem solving skills and work independently as well as in a team.
Lakeland Regional Medical Center Lakeland, FL
Managed Care Analyst 5/2009 – 6/2012
2/2005 – 10/2006
Database reporting with Crystal Reports, Access, Excel and Monarch
Contract modeling with Concuity and MedAssets contracting system
Contract structure with emphasis on past, present and future financial modeling
Database extracts and conversion
Managing data analyses to identify contract discrepancy trends, and manage the follow-up with the managed care calculations verses managed care payer calculations
Lead Managed Care meetings and contract discussions with Payers
Coach/train Administrators and ASC Business Office staff on managed care, contracts and reimbursement
Assist in analysis and recommendations to ASC/surgical hospitals clients, and operations team for reimbursement and contracting strategies
Maintain good third-party payer relationships with the managed care community and governmental payers
Conduct oversight and monitoring of all manage care contracts as needed
Routinely interact with various internal and external contacts including LRMC Management and managed care payers
Communicate effectively with other internal departments to recommend improvements
Analyze information in order to direct appropriate actions to maintain a favorable financial situation
Contributing to strategic planning; strategy implementation; planning, organizing, directing and conducting the negotiations; and implementation of managed care agreements with current and prospective purchasers or providers of healthcare services
Securing optimal reimbursement and protecting the interests of the hospital in contract negotiations and the implementation and management of managed care contracts and relationships
Coordinate implementation of HMO, PPO, and other managed care contracts with Patient Financial Services, Admitting and Case Management
Develop, implement and maintain methodologies to ensure receipt of proper payment from contract payers including periodic assessments of contract compliance
WellCare Health Plans Tampa, FL
Senior Budget / Financial Analyst 10/2006 – 5/2009
Develops ad-hoc reports to conduct data analysis and validation
Researches methodologies and conducts advanced metric reporting
Analyzes trends to recommend process and/or operational improvements
Prepares detail and summary level reports including written interpretation of analytic results
Presents results to management, including data-driven business recommendations and alternatives
Evaluates financial impact of implemented initiatives
Conduct special projects requiring a high degree of confidentiality and expert knowledge of multiple departments within the company
Establish databases of pertinent information for use in analyzing future plans and forecasts
Identifies trends and recommends improvements accordingly
Analyzes financial information to determine present and future financial performance
Work with business units to establish metric standards
Coordinate monthly close process with Operations Finance and Accounting ensuring accuracy of monthly financials
Provides decision making support and improves the financial/accounting expertise throughout the organization
Tracks and reports non-capitalized project and program expenses against budgets and forecasts
SUNY@Stony Brook University Hospital Stony Brook, NY
Senior Staff Assistant for Transplantation Department 5/2003 – 9/2004
Database management and updates
Database reporting using Access and Excel
Hardware and software configurations, troubleshooting and repairs
Network updating and reporting of UNOS (United Network for Organ Sharing) database
Update and report MDEverywhere network database
Project analysis and management with recommended solutions
PACS system concepts certificate from Kodak Health System Imaging
Doctors Care Network, Inc. Great Neck, NY
Eligibility Analyst/Database Coordinator 6/2001 – 3/2003
Analytical Coordinator of facts and details
Database management with query tools such as MS Access & Excel
Maintain and modify tables, queries and other data relationships
Aggregate database for analysis using specific software applications
Updating of providers and members database eligibility
Resolve eligibility problems with physicians and/or members
Collect, validate data integrity and reconcile results
Help identify, evaluate and implement best practice procedures
Participate in on-going training and departmental developments
Translate user requirements into technical specifications, designs and reports
Troubleshooting and application support
North Shore/LIJ Health System Lake Success, NY
Central Processing Supervisor 9/2001 – 9/2002
Experience in operating Cerner system and various medical software
Supervise staff of 15 in ensuring all specimens are inputted correctly and on a timely basis
Administrative paper work including payroll, assignments schedule, compliance and hiring/terminations
Customer service/resolving issues with physicians and /or patients
SmithKline Beecham/Quest Diagnostics Syosset, NY
Central Processing Supervisor 12/1991 – 9/2000
Supervise staff of 100 plus ensuring all blood specimens are log in properly and correctly
Extract departmental database to create weekly work and vacation schedules
Create and update databases for department
Run production reports using excel and access
Administrative duties including disciplinary and hiring of employees
Customer service/resolving issues with physicians or patients
Education:
B.S. Computer Science, 1987 to 1991
Queens College, Flushing, NY
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