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Work Background
WellSense Health PlanBusiness System Analyst III
Jan. 2016Greater Boston AreaAnalyze current state and evolving organizational needs in order to configure projects, develop prototypes, and perform proof of concept testing in support of changing business requirements. Approve test plans and assist with implementation. Engage members of interdepartmental workgroup to address ongoing systemic organizational changes. Bridge communication gaps between departments to find common language and goals.
Blue Cross & Blue Shield of Rhode IslandConfiguration Analyst
Nov. 2011 - Dec. 2015Providence, Rhode Island AreaAnalyzed business requirements in order to translate desired outcomes into system configuration solutions. Extracted tables and data in order to derive best practices and apply them. Documented, designed, built, and tested concepts to improve functionality in Facets enterprise software. Engaged customers and executive management on project status and outcomes.
Blue Cross & Blue Shield of Rhode IslandGrievances & Appeals Case Specialist
May. 2010 - Nov. 2011Providence, Rhode Island AreaEngaged providers and member inquiries into billing discrepancies, investigated underlying cause, and corrected issues as appropriate. Educated stakeholders and conducted troubleshooting within the system on their behalf. Coordinated appeal reviews and communicated final determinations to providers.
Blue Cross & Blue Shield of Rhode IslandSenior Customer Service Representative
Mar. 2007 - May. 2010Providence, Rhode Island AreaLed, mentored, and coached team of 10-15 customer call center staff responding to daily inquiries from members and providers. Provided staff guidance in resolving ambiguous situations and engaged callers directly during issue escalations. Analyzed processes to improve productivity and improve customer experiences.
West Bay Orthopaedic MedicalMedical Billing Specialist
Jan. 1998 - Dec. 2005Warwick, Rhode IslandMonitored all electronic claim submissions to ensure end user delivery. Analyzed and reconciled unpaid claim reports; initiated telephonic and written requests for processing which reduced unpaid revenue. Accurate entry of physician provided services for insurer reimbursement. Contributed to the success of the practice through training and mentoring of new staff. Organized and coordinated the distribution of daily work. Coordinated high level customer issues to ensure patient satisfaction.
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