Inventory Management Risk

Prenella O. Jacob

Boston MA ***** 857-***-**** **************@*****.***

SUMMARY

Trusted Manager with extensive analytical skills and experience in both the healthcare and finance industries. Known for developing highly effective teams that meet quality and productivity standards. Recognized for creatively solving complex systems issues with creative thinking. A collaborative communicator, with a strategic and innovative style to effortlessly increase automation, by streamlining processes for optimal efficiencies, to aid in reducing cost.

Business Partnering Relationship Management Operational/Analysis

Sr. Management Communication

Customer Focus/Satisfaction

Inventory Management/Reduction

Strategic Initiative Implementation

Client/Vendor Management

Roster Reporting/ Data Specification/Metrics

Due Diligence-Controls

Managing Projects

Documentation: Ops Procedures, BRD’s

Internal/External Audit Mgmt.

Process Improvement

Ops Efficiencies/Reengineering

Compliance/Risk Management

Process Documentation

DataAnalysis: QA/UAT/TESTcases/Big Data

Technical/Analytics:

Operating System: Salesforce, FPRS, DST, Monument, Oracle, Bene-Soft, SYMPLR,

Software: Microsoft Office, SQL, Share point, CLIQ, Business Objects, Optum, Lotus I-notes, Service Now, Teams

Hospital Reimbursement Payment Methodologies: APR-DRG, MS-DRG, eAPG

Leadership:

Manager/Supervisor: Ability to align myself with the vision of a successful organization; Applies job/business knowledge to aid in making effective decisions and sound judgement; act with integrity; leads and influence others; encourage inclusive and collaborative behavior, contributes creative ideas, embrace and manage change.

Finance: Knowledge of ERISA laws, Qualified/Non-Qualified Retirement Plans, Form 5500 Reporting,

Healthcare: Public Sector (M-Caid/M-Care), Supplemental Benefits. Solid understanding of EOHHS/CMS Regulatory Requirements, CPT, HCPS, ICD-10, various coding guidelines.

Logix Health

Senior QA Manager: June 2023 – Nov 2024

●Managed an Audit team responsible for reviewing and processing physicians CAQH enrollment applications, as well as qc’ing enrollment applications within the department..

●Research projects related to rejected/denied claim coding and billing issues to solve for inefficiencies

●Facilitated team meetings and conducted coaching sessions on associates growth and development/ Attend and participate in all department related meetings

●Participate in meetings with external vendors, as well as other SHCN departments on relatable issues Re-evaluate enrollment Audit business requirements and document solutions for optimal effectiveness

●Identify gaps in business processes and provide methods needed to streamline inefficiencies

●Assist in the development of receiving files/rosters from external clients to assist in Systematic Audits

●Assist in developing and building of daily, weekly and monthly enrollment reporting

●Monitor Team performance to ensure workflows are being utilized

●Review and research payer rules and regulations for enrollment processing/Communicate new or updated policies across departments

●Work closely with development teams in documenting, testing and implementing new enhancements

Steward Health Care Network

Enrollment Analyst/ Supervisor: 2019 – 2023

●Managed, coached, and developed a team of direct reports, responsible for processing enrollment applications for providers within the Steward Network.

●Monitored work queues for volume control, and ensure associates met SLA’s.

●Facilitated team meetings and conducted coaching sessions on associates, growth and development

●Participate in meetings with external vendors, as well as other SHCN departments on issues and updates

●Prepare, reconcile, and transmit enrollment data files to various Health Care Payors

●Evaluate enrollment business requirements and provide solutions for optimal effectiveness

●Identify gaps in business processes and provide methods needed to streamline inefficiencies

●Develop and maintain timely file transmissions between external vendors and SHCN

●Assist in developing and distributing daily, weekly and monthly enrollment reporting

●Work closely with development teams in documenting, testing and implementing enhancements

Tufts Health Plan-Public Plans

Reimbursement Configuration Supervisor: 2014 - 2019

●Managed, mentored and developed a team of Analysts and specialists, whose responsibilities included: configuring new or amended contracted rates, updating Provider/Hospital Fee Schedules for accurate reimbursement, assisting with Provider/Hospital Claim research and analysis for Retro-active adjustments, Regulatory /coding updates, Reporting.

●Queried and quantified data for accurate reporting specifications as well as for preparation of Quarterly dashboard reports. Completed QC of all configured changes in TEST environment

●Documented, Maintained and Implemented department policies and procedures

●Build effective relationships with business partners, took initiative to streamline processes

●Analyzed complex configuration processes and assisted in providing methods for solutions

●Developed and maintained custom reporting to track inventory and productivity, actively monitor work queues for distribution and prioritization

●Facilitate team meetings, and functional work sessions, conduct coaching sessions and provide feedback on

●employee growth and development, Ensured staff accountability on SLA and standard turnaround, also facilitated combined departmental meetings in order to discuss various stages of configuration issues and determine best solution options.

●Completed metrics for staff compensation, documented and conducted annual performance appraisals and development plans, approved EE timesheets timely

●Supported and participated in the Implementation and Testing of departmental projects, initiatives, system driven fixes, and enhancements

●Managed Account Set up and ongoing maintenance of claim research and reconciliation

The Hartford – Retirement Service Group /Wealth Management

Service Operations Manager: 2008 – 2013

●Managed, coached, and developed a team of 12 direct reports, responsible for correcting issues with participant loans, withdrawals, transfers, exchanges etc.

●Monitored work queues for volume control, and ensure associates met SLA’s.

●Facilitated team meetings and conducted coaching sessions on associates, growth and development

●Conducted qc on New Business account set up, as well as ensured 100% qc of less tenured associates

●Documented and delivered associates reviews, and development plans

●Perform QA on production upload of nightly pricing files from various outside mutual fund companies

●Escalated and fixed pricing errors before nightly cycle of production activity

●Analyzed monthly reports for trending purposes, utilized in senior management departmental organizational updates

●Participated as a subject matter expert in requirement sessions for system fixes and enhancements

MFS Investment Management

Conversion Analyst: 2006 – 2008

●Worked independently as part of a project team to successfully move over 50 Billion in assets to an open architecture platform

●Created, maintained, and amend documents, and plan service agreements based on legislative changes or plan sponsor request

●Constantly communicated with wholesalers, brokers and client/relationship managers to ensure clients expectations and deadlines were met

●Act as primary interface between Project Managers, Business Unit and Systems Development areas

●Created and designed the Plan Administrators Manual for new Client Conversations

●Documented requirements, and operational processing to accomplish New Business Objectives

●Utilized codes from an Integrated (Oracle) Data Base, to design, build, and develop detailed Client Reporting specifications,

●Interpreted systematic problems and provide initial analysis toward resolution

●Developed test cases and identified Test populations for UAT and Regression testing

●Assisted in Testing of Web and Phone System for New Business client Onboarding

●Processed and audited various Plan Level Functional requirements: Asset Reallocations, Plan Mergers, Within Plan Transfers/Exchanges, Source Rollovers, Investment Mix Moves, Price fixes, Administrative fees, Annuity reporting, Form 5500 Preparation.

●Assisted with the identification of test data cases and / or performed UAT on various projects, installations, or system enhancements

EDUCATION:

Coursework taken towards BS, HealthCare Management

Cambridge College, Cambridge MA

University of Massachusetts, Lowell, MA

CERTIFICATIONS:

HIPPA Certified

Certified System Administrator

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