| Candidate Information | | Title | Project Coordinator | | Target Location | US-MI-Davison |
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Click here or scroll down to respond to this candidateEducationMott Community College, Associates Degree with Honors in Arts, Graduated in Street Address
Work ExperienceBlue Cross/Arrow StrategiesProject Coordinator, February 2023 PresentSupport the Portfolio Manager and Senior Project Manager to implement multiple projects.Initiate, plan, execute, control and close complex application and system implementation projects.Monitor and update multiple Project Status ReportsEnsure expectations are developed, controlled, executed and met in a timely manner.Assist in establishing and improving project management.Prepare necessary presentation materials for meetings.Maintain documentation appropriately for each project and its needs.Schedules and provides notes from project meetings etc.Provide administrative support as needed.McLaren Health Plan, May 2004 February 2023Business Analyst, November 2019 February 2023Support all departments with configuration questions/requests, documentation and problem solving for all healthcare coverage plans offered. (Medicaid, Healthy Michigan, Medicare Advantage, Medicare Supplement, TPA, Large Group, Small Group and Individual.)Translate benefit and reimbursement requirements into functional specifications.Configure, test, document and maintain benefits for system configuration.Assist with the Federal and State filings, including Commercial Products, Medicaid, etc.Process new groups, plan changes, terminations, and renewals for the commercial line.Create and maintain job aids and procedures for the Business Information department.Train and transition personnel on new and existing processes and procedures.Continued to perform several tasks of the Business Project Coordinator position.Business Project Coordinator (Operations), November 2014 - November 2019Managed and oversee assigned projects for the Operations, Sales, and Marketing Departments.Identified and implemented opportunities for improvement with staff training for new and existing policies and procedures.Analyzed, researched, and resolved internal and external department, and vendor issues.Verified benefits for professional and institutional claim adjudication.Maintain master library of documents including COCs, BIBs, SBCs, and Schedule of Benefits. Considered as the source of truth for the Company.Coordinated and submitted the QHP application, Medicaid, and Appeals/Grievance fillings.Point of contact for CMS and DIFS.Collaborated with Configuration Team in implementing group/agent updates on Health Rules.Benefits Coordinator, June 2007 - November 2014Served as focal point for all commercial service requests from enrolled groups.Worked with sales team and outside agents to process new and renewing group enrollments.Assisted in the development of group, and member sales and marketing materials.Maintained the quoting templates for all groups and individuals.Underwrote all commercial large/small groups and individuals requesting quotes or renewals.Ran rate quotes for individuals, small, and large groups, including benefit summaries.Coordinated internal agent, group, and member mailings and with external vendors.Assisted the Membership Supervisor by monitoring department workflow and answering inquiries.Senior Membership Analyst, August 2006 - June 2007Performed daily, weekly, and monthly audits of workflow completed by Membership Analysts.Oversaw the ID card file production for all lines of business.Developed procedures for all Membership/Sales Support functions and the training of staff.Performed over 2,500 enrollment additions, changes, and terminations, annually.Administered COBRA for all McLaren subsidiaries.Corresponded with the Pharmacy Manager daily.Researched and resolved all issues regarding eligibility for all enrolled groups and individuals.Point of Contact for all departments on questions related to Membership and Sales Support.Membership Analyst, May 2004 - July 2006Loaded all Membership/COBRA applications onto system, including PCP assignments.Received and respond to employer and provider inquiries regarding membership and eligibility.Produced ad hoc reports as required, and evaluate when/if to integrate with standard reporting.Processed incoming and outgoing HIPAA certificates and ID Cards.Downloaded enrollment/disenrollment files from the State of MI to ensure accuracy.Knowledge, Skills, and ExperienceProficient in the use of SERFF, HIOS, Salesforce, TEAMS, Outlook and Microsoft Office applications.Recipient of multiple employee of the month rewards, and peer recognition awards.Excellent research, analytical, problem solving, project management, multitasking and time management skills.Flexibility to pivot in job duty priorities to handle multiple projects simultaneously.Participated in the implementation of converting FACTS to Health Rules.Excel at utilizing strong communication skills.Excellent research, analytical and problem solving skills.Ability to make comprehensive recommendations and/or analyses of situations.Implemented continuous improvement projects.Experience with billing for COBRA and McLaren retirees. |
