Experience

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  Health solutions plus

  Jan 2010 - Dec 2018

  Performed gap analysis at the onset of implementations to determine if any software enhancements are required prior to client go-live. Analyzed client requirements and provided several options on how best to configure the software. Gathered and documented requirements from client to ensure all system configuration meets business needs. Worked with internal developers on conversion of legacy data into HSP data format.Traveled to client sites throughout project lifecycle. Provided training while on site on system functionality to client end users. Met with key client stakeholders while onsite to provide project status and key milestones. Assisted client reporting team when developing reports to best utilize all available data. Updated project plan as needed to ensure up to date status was being reported to internal and external stakeholders.Specializations:- SME in all Finance aspects of system- Federal and State Health Exchanges- SDLC- 834, 837, and 835 X12 HIPAA Transactions- Data Conversion Show less Served as main point of contact for 3-6 healthcare payer clients. Provided guidance on best practices for how to use the HSP product suite. Assisted clients in configuration and testing when they brought new lines of business onto the software. Investigated possible issues with the software that were raised by clients. Tracked all communication with clients through CRM application to ensure timely responses on all tickets that were entered.Traveled to client sites to discuss current operations and any future enhancements they may need. Discussed current business operations and provided guidance on how best to optimize day to day processes. Analyzed client data and reconfigured system to achieve highest auto adjudication rate as possible. Assisted clients with testing new system functionality when new software versions were released.Specializations:- Client Relations- System Configuration- Dental Carve Out Plans- Third Party Administrator Health Plan Show less Created test plans/uses cases for new product enhancements. Tested new product enhancements during release cycle to ensure new functionality and previously existing functionality work properly. Provided feedback to development team on new enhancements and how they fit in the software. Created test scripts for automation tools used to remove manual testing of certain product features. Tracked all testing via ticket system to ensure all tickets were tested and finalized for their respective releases.Lead QA Analyst on several new product enhancements including; Premium billing functionality, Medicare Advantage file automation, and provider capitation enhancements. Worked directly with developers to discuss any issues that came up during the testing process. Wrote up system documentation for clients for how they would best use the new product features. Traveled to client sites to review business requirements for new system enhancements. Tested both web and desktop based applications.Specializations:- Premium Billing Invoicing- Medicare Advantage file processing- SDLC- Requirements Gathering Show less

  • Software Implementation Specialist

    Mar 2014 - Dec 2018

  • Client Services Representative

    Jan 2012 - Mar 2014

  • Quality Assurance Analyst

    Jan 2010 - Jan 2012
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  Conduent

  Jan 2019 - Oct 2022

  Responsible for cultivating strong relationships with key stakeholders from healthcare payer clients from project inception through post go-live. Determine if any gaps in functionality are critical for go-live. If there are critical gaps create business requirements document for development. Ensure any necessary enhancements are added to product roadmap and will be delivered in time for go-live. Manage rapidly growing team to ensure cross functional areas work closely together. Ensure resources are allocated properly across multiple projects to achieve on time system go-live. Specializations:- SME in claims payment, premium billing, and provider capitation- Healthcare Payer Organizations- Core Claims/Administration Platforms- Medicare Advantage- Business Process Improvement- SaaS- BPaaS Show less Worked on multiple implementations simultaneously. Analyzed client data to understand optimal configuration on Conduent platform. Deciphered complex client use cases during discovery to create functional configuration requirements. Translated client uses cases into business requirements documents that were used for system configuration. Achieved at least 80% auto-adjudication of claims through the system where no user interaction was needed. Traveled to client site during implementation to build strong relationships with key client stakeholders.Managed a team of 8-12 direct reports. Mentored and coached team members to build their knowledge base. Trained new employees on system functionality. Performed annual reviews and provided constructive feedback to employees to build on in the next year. Specializations:- SME for all Finance related configuration- Delegated State Medicaid Programs- Legacy Data Conversion- 834, 837, and 835 X12 Transactions Show less

  • Senior Manager, Product Management

    Sept 2021 - Oct 2022

  • Manager, Business Analyst

    Jan 2019 - Aug 2021
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  Caqh

  Oct 2022 - now

  Technical product manager

  As the Technical Product Manager I oversee the entire product lifecycle including requirements analysis, design, planning, development, and deployment. I serve as the technical product lead where I collaborate with cross-functional teams to define and develop new products. With input from the cross-functional teams as the TPM I prioritize all development work to ensure all deliverables on the product roadmap are met.Responsible to build out an 18 month backlog to ensure there is no downtime for developers between projects. Maintain an open dialogue with development team during backlog refinement to assure all requirements are understood prior to development work starting. Conduct meetings with health plan Payment Integrity teams to obtain feedback on how the current products are being used and to discuss future enhancements. Prioritize development work based on what will provide the most client impact and provide the highest ROI.Specializations:- Health plan member data- NAIC primacy guidelines- State Specific Primacy rules Show less