Experience

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  Kaiser permanente

  Jan 1995 - Jan 2004

  Involved in a specialized program that helped low income Kaiser Community patients obtain needed medical care by subsidizing their co-pay.Interviewed patient, non-members, industrial patients, and patients waiting in Emergency room to address their concerns relating to payment and ensuring that Kaiser would not be affected financially. Negotiated payment methods for self-pay, non-member and approved or denied need for financial assistance prior to treatment. Thorough knowledge of Government programs and alternate pay or sources, including Worker Compensation, Medical, Medicare, Commercial.Thorough understanding of Medicare and Medical as it related to this group.Arranged hospital stay(s) and subsequent office visits including determining co-pays prior to appointment. Show less Working in a fast pace environment, strong knowledge of federal and state regulations, law and accreditation standard related to health care and manage care organizations. Strong Medical, Medicare, Contract Unit background. Processed claims In-Area, Out-of Area, Contracts, Medicare and Non- Contracts, Contract Areas. Process 85 claims for all area line of business. Self-starter and very organized. Specialized processing of Dural Medical Equipment and Drug claims.Answer high volume of phone calls from Kaiser members. Assisted supervisors with special projects for my department.Trained employee in processing claims and learning the different systems. Show less

  • Financial Counselor

    Jan 2001 - Jan 2004

  • Claims Examiner- Processor

    Jan 1995 - Jan 2001
• 

  Kaiser permanente

  Feb 2004 - now

  Liaison between business users and IT. Responsible for ensuring all issues are resolved in a timely manner. Requires in depth knowledge of various systems. Drive client meetings as needed. Facilitate release planning for the monthly release.Accountable for resolving all DOTS interface errors and rejections. Trouble shooting all DOTS system error for all users which includes, Physicians, Clinician, and DME staff. Lead all business side activities associated with new releases including test scenario documentation, User Acceptance testing, documenting results, documenting business communications, and training as needed.Responsible for development and distribution of communications related to system outages, new functionality, issues, and upcoming releases.Manage all onboarding and off boarding DOTS system access requests. Ensure all vendor reporting is completed in a timely manner.Accountable for biweekly & quarterly access and SOX reviews.Liaison between the DOTS business and IT for regional and national initiatives. Show less Responsible for all planning, budgeting and timelines as well as program governance for this large complex projects. Develop the strategies and approaches for organization of the program office. Facilitate the definition of program scope, goals and deliverables. Managed programs through design, implantation phases. Plan all aspects of programs including but not limited to, Strategic Accounts, local client contract health screen processing and all related training. Lead all phases of projects, from concept through deployment, including needs assessment, system requirements determination, planning, scoping, scheduling, budgeting, development, testing, and implementation. Conduct business impact and cost/benefit analysis evaluations and recommend the appropriate course of action for assigned projects.Responsible for accurate and timely status reporting across the program, recommend actions and determine priorities with the Business and IT stakeholders. Show less Analysis, Design, Build and Unit Testing Provider Contracts and Benefits within the KPCC Platform. Strong knowledge in analyzes business requirements to determine the best approach for configuration design.Create and maintain National Configuration Design Templates as “Build Artifacts” to be used by Configuration and Testing teams throughout the implantation GO Live phase. Manage provider contracts and benefits administration data within the KPCC platform to support the accurate and timely payment of claims. Lead areas of configuration designs for one or more areas, including areas outside of Claims, within ClaimsConnect Platform.Develop a strong skill set and implement new processes and workflow to improve tracking, accountability, time management and organization.Creating and maintaining workflow process. Strong knowledge of the Tapestry workflow. Lead business requirements development and solution design process including creation of requirements, and design documentation along with facilitating sessions with business owners. Conducts systems requirement assessment in support of regulatory changes (e.g. ICD-9, ICD-10, ASC, CPT, HCPS, DRG etc.). Show less Coordinate project deliverables/issues with key stakeholders. Routinely completes complex assignments requiring independent action, and a high degree of initiative to resolve issues with consistency and accuracy. Collect data from all staff, working in a corporate compliance environment, being accountable each case. Strong knowledge large group meetings, conference call, and audio-visual equipment, Coordinate processes for Appeals and Grievances. Doctors, Nurses, Benefit key holders for success rate for decision outcome due to compliance regulation.Guide Team on Appeals/ Grievances processes and protocols. Analyze source data and identify risks. Identify areas of improvements for service and performance of Compliance tools and processes. Organize the Team workflows and processes for all cases in a time sensitive environment. Successfully utilized cloud-based centralized databases that effectively maintained a paperless and well-organized work environment.Develops and maintains project document for all cases. Documents and updates procedure, decisions action items/issues logs. Conducting quarterly reporting for all cases within compliance regulations. Creates status reports, resource management reports, project status reports, and other customized reports.Utilized proven verbal and written communication skills for providing liaison services to Medicare members that filed disputes regarding services, procedures and/or products with the Health Plan. Maintained an excellent understanding of a multitude of complex and constantly evolving Medicare, State of California, and Federal regulations that were required to meet full case compliance obligations.Compiled investigative finding reports that assisted various review committee decision makers with grievance and appeal determinations. Show less Handle all aspects of representing proprietary product from introduction to post implementation supportConduct and interpret quantitative analysis. Provide IT support for end users and GO Live for Northern California for Kaiser Permanente Medical Center. Collect data and provide analyses for a broad array of healthcare redesign issues across multiple disciplines and functional areas.Analyze business processes and functional requirements from moderate to complex in scopeDevelop business cases, and provide client support during KP HealthConnect system development and implementation.Carry out detailed tasks assigned by projects teams. Demonstrate proprietary software to all hospitals covering all of Northern California. Coordinate team efforts on critical projects with accelerated time schedules to help define and execute on projected deadlines.Collects data and provides analyses for a broad array of issues across disciplines and functional areas. Has sole responsibility for some small to medium size analytical projects. Works under limited supervision. May be dedicated to a single department or business unit.Prepares reports synthesizing analytical results, highlighting implications of findings. Follows through any further actions based on the results using sound business judgment. Conducts quantitative and qualitative analyses on a broad array of issues across disciplines, projects and functional areas. Structures and executes analysis independently. Contributes to practice development and department administration including such tasks as debriefing on training and developing thought pieces on topics like change management. Demonstrates initiative in identifying alternative solutions to issues in the project or department which are reasonably complex and require an understanding of how the outcome will affect multiple areas/ departments.Epic Proficiency/ ADT, ED, L & D , HIMS, Ambulatory, Scanning Show less

  • IT Project Manager

    Oct 2016 - now

  • Project Manager

    Jul 2015 - Oct 2016

  • Senior Configuration Analyst

    Mar 2014 - Jul 2015

  • Case Manager/ Project Manager

    Feb 2007 - Mar 2014

  • Business Application Consultant

    Feb 2004 - Feb 2007