Real Estate Data Entry

Experienced Technical Analyst with **+ years in the healthcare industry, specializing in TriZetto

Facets data analysis and configuration, pricing strategies, product configuration, requirements gathering and operational enhancements. Recognized for strong problem-solving skills, driving customer satisfaction, and fostering productive relationships with internal and external business partners. Proven ability to identify opportunities for process improvements and contribute to overall business efficiency.

KARI DUELL

1784 Palomar Terrace * Naples, FL 34120 **********@*****.*** 518-***-**** CONFIGURATION AND SYSTEMS ANALYST

Pricing and Product Configuration Analyst III, CDPHP Jan 2013 - June 2021 Performed detailed analysis and configuration of all provider contracts, agreements, fee schedules, qualifier groups, etc. using TriZetto Facets NetworX Pricer and integration to Optum payment methodologies.

Recommended and implemented system configurations for TriZetto Facets and alternative solutions to align with business objectives, resolving deficiencies and optimizing functionality for improved efficiency.

Oversaw root cause analysis activities, including the development, implementation, and tracking of process improvements of Trizetto Facets to enhance operational efficiency and issue resolution.

Established consistency and standardization across tools, processes, deliverable templates, change management protocols, business models and process flows to ensure alignment and efficiency.

Maintained effective, cooperative working relationships with people both internally and externally as it related to the operations and internal company business. Analyzed claims data sets to evaluate patterns of billing as it relates to benefit design and configuration.

Developed extensive quality assurance tests to assess the impact of configuration changes. Owner/Vice President, All Star Plumbing

Led all aspects of business operations, from startup to successful sale. Developed and implemented standard operating procedures (SOPs) to streamline efficiency, ensure compliance, and enhance service quality.

Oversaw business growth, financial management, and strategic planning, positioning the company for scalability and profitability.

Built a strong customer base and optimized operations, ultimately making the business an attractive and successful acquisition.

Integrated FieldEdge software with QuickBooks for seamless synchronization of financial data and service operations; connected with call management resource answering service software to streamline dispatching, scheduling, and customer communications. Supported product and pricing configuration initiatives on an ongoing basis during this time by referencing and analyzing the TriZetto Facets Core Solution Medical Provider Agreement and Pricing Profile Guide as well as Facets Core Solution Medical Plan Reference User Guide to stay current and sharpen configuration skills.

PROFESSIONAL EXPERIENCE

SUMMARY

June 2021 - Feb 2024

Was primarily responsible for maintenance and accuracy of application guidelines by developing, documenting and maintaining; departmental standards, policies and procedures, SOP’s and standardized configuration templates.

Attended meetings as a knowledgeable representative from Configuration with the ability to determine issues affecting the department as well as making sound decisions on behalf of TriZetto Facets configuration, and informing department management. Participated in conversion and interface sessions assisting in the decision-making and requirements development of TriZetto Facets initiatives. Acted as key liaison between business and technical teams, facilitating knowledge transfer of TriZetto Facets NetworX applications to client personnel to ensure seamless adoption and operational understanding.

Executed comprehensive testing and validation of TriZetto Facets benefit and provider pricing configuration to ensure system stability and performance of claims processing. Ensured all TriZetto Facets related activities adhered to industry standards and regulatory requirements, maintaining full compliance throughout project lifecycle. Trained and mentored junior team members on TriZetto Facets functionalities and best practices, including but not limited to; onboarded new hires by documenting pricing configuration procedures, created Confluence workflow pages for cross-functional ticket triage, and guidance on NYS DOH Custodial Benchmark rates.

Facilitated effective communication by sharing timely project and work updates in recurring team and client meetings.

Proactively developed comprehensive client meeting agendas that outlined critical project milestones, driving progress and exceeding expectations. Business Analyst III, Clinical Integrated Platform, Anthem (WellPoint) Sep 2009 - Jan 2013 Project: Clinical Integrated Platform (CIP) Enterprise Wide – Collaborated with Care Management Operations areas, including business champions, configuration team members, work stream leads and Trizetto Clinical Implementation team to document multi-million dollar Clinical Integrated Platform project business requirements, design workbooks, activity diagrams, use cases, SIT and UAT test plans and supplemental training documents.

Supported first successful implementation of Clinical CareAdvance, Trizetto hosted Utilization and Care Management application within very aggressive 6-month timeframe from September 2010 to March 2011.

Actively led effort, including JAD and brainstorming sessions building all case management, clinical content and data entities for CCA user interface; developed complex business rules to achieve proactive management of populations; helped reduce costs and personalize interventions by leveraging data through analysis of actionable reports for Northeast region. Successfully led SIT and UAT testing effort with aggressive timeline for CCA CM implementation, including creation and execution of test scripts with prompt and efficient defect triage and/or resolution.

Coordinated all activities and meetings to support various issues, defects, planning and implementation of test scripts.

Collaborated with trainers ensuring training materials matched functionalities in CCA application. Continually offered improvised support to sustain aggressive go-live timeline and production support.

Consistently utilized creative problem solving skills to tackle roadblocks and/or issues as they arose through constant synchronization of cross-functional teams, utilizing (external) Onyx and

(internal) IBM Rational ClearQuest software for defect tracking and resolution maintaining visibility and control within SDLC.

QA Testing Analyst, MVP Healthcare Jan 2008 - Sep 2009 Developed and executed test plans and cases to validate claims data flow and ensure accurate processing of healthcare transactions.

Wrote and maintained detailed test cases, ensuring comprehensive coverage and reproducibility of test scenarios.

Identified, documented, and tracked defects in healthcare applications, collaborating with development teams to resolve issues using JIRA system. Executed SQL queries to retrieve and validate data from databases, performing backend testing and data analysis.

Collaborated with healthcare stakeholders, including clinicians and administrators, to understand requirements and ensure alignment with business needs, including with UAT test effort. Effectively communicated test results and findings to development teams, facilitating problem- solving and issue resolution.

Analyzed business and technical requirements to design and execute effective testing strategies. Project: MaxMC Medical Management Software –

Served as primary “Lights-On” production support, System Administrator and Subject Matter Expert (SME) for Case Management and Care Management modules of maxMC. Created, updated and tested changes to complex business rules, simplified processes with system efficiencies, maintained HIPAA compliance and reduced costs of administering health plans.

Planned and executed testing effort for maxMC configuration and application functionality changes, working closely with IT and business resources. Diagnosed and resolved technical production issues on daily basis. Provided system configuration and implementation support to all enterprise clinical project initiatives slated under Medical Business Solutions, with 100% time allocation to maxMC from 2006 – 2008.

Successfully implemented client subsystem and other configuration for maxMC implementation iterative rollout.

Implemented new accounts on maxMC system successfully allowing claims to be processed efficiently and on time.

Project: Managed Care Coordination/Preceptor –

Answered queries from doctor's offices, hospitals, institutional providers and insured; verified eligibility; determined content of inquiry following preauthorization process. Promoted to Managed Care Coordinator II in November 2002 to handle inquiries and requests for all lines of business.

Successfully completed Preceptor Training Program. Trained 5 Managed Care Coordinator Employees for Call Case Triage. Systems Analyst SME/Managed Care Coordinator, Anthem (WellPoint) June 2000 - Jan 2008 High School Diploma

Tamarac High School - Troy, NY June 1996

EDUCATION

SKILLS

Excellent utilization of SQL to query relational databases and extract data needed for accurate and efficient configuration within core systems

Easily able to adapt to changing work priorities and a fast-paced environment while maintaining a professional attitude

Demonstrated expertise in Configuration within the Facets Application for both Pricing and Product Excellent written and verbal communication skills, with a special ability to build positive and reliable relationships across business platforms - example: identified as a key contributor to attend the ASO/Configuration Customer Intimacy Team to help build a better working relationship interdepartmentally

Deep understanding of key integration points within TriZetto Facets Agreements; strong knowledge of Facets NetworX Modeler and Facets Integrated NetworX Pricer Skilled in reimbursement methodologies with the ability to interpret and translate them into system requirements and design specifications

Extensive experience in Microsoft Excel, creating and editing spreadsheets Strong background in regulatory compliance in HIPAA, ERISA and ACA requirements

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