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Click here or scroll down to respond to this candidateCandidate's Name
Arlington, WA PHONE NUMBER AVAILABLE EMAIL AVAILABLEhttps://LINKEDIN LINK AVAILABLESenior Business Analyst/ArchitectExperienced Business Analyst and Architect with over 25 years in the healthcare industry. Working with both Payers and Providers bridging the gaps between technical and non-technical stakeholders. Specializing in Business Process Improvement, Requirements Gathering Analysis and Visualization, and Organizational Change Management.Areas of ExpertiseBusiness Analysis Project Management Technical Support System Configuration TrainingChange Management Solution Implementation Risk Management Gap Analysis Agile and Lean MethodologyCare Management Procedure Writing Business Architecture Process Mapping Strategic PlanningCustomer Journey Maps Member Enrollment Product ConfigurationProfessional ExperiencePremera Blue Cross, Mountlake Terrace, WA February 2014 - November 2023Business Architect, Enterprise Architecture, November 2021 - November 2023Served as team lead for enterprise architecture and business process modeling training development and deployment across Premera.Led the strategic planning and execution of enterprise content management system processes using Bizzdesign ensuring alignment with business objectives and operational efficiency.Designed and implemented comprehensive process maps for content lifecycle management, enhancing system usability and team productivity by 30%.Collaborated with cross functional teams to identify, analyze, and optimize key processes, resulting in a 20% reduction in content retrieval times and a 25% improvement in compliance with data governance standards.Facilitated workshops and training sessions for stakeholders, increasing adoption of the new processes and tools by 40% within the first quarter of implementation.Utilized Bizzdesign to conduct thorough gap analyses, identifying critical areas for improvement in the content management lifecycle, leading to 15% decrease in operational costs.Spearheaded the integration of Bizzdesign within existing IT infrastructure, ensuring seamless data exchange and enhancing system operability by 50%.Developed and maintained comprehensive documentation of all content management processes, serving as a vital resource for ongoing training and system maintenance.Drove clarity across stakeholders through consultation and creation of architecture work products.Created and maintained enterprise models with the enterprise architecture repository.Collaborated with solution architects on logical architectures and solution design.Business Analyst, Enterprise Architecture, May 2019 - November 2021Partnered with business units and IT to map approved work efforts to architectural future state business and system requirements and tracked successful implementation of target state through a massive enterprise wide transformational effort.Identified opportunities and made recommendations based on data analysis and consideration of future impacts.Maintained all database tagging and indexing rules across all related dimensions.Supported analytics for multiple enterprise-wide projects, initiatives and mandates including: Claims Re-Platform, Provider Contracting, Provider Directory, Provider Relations, Member Experience, Managed Care, Content Management System, AI and multiple Process Improvement efforts.Senior Product Configuration Analyst, Product Configuration, September 2016 - May 2019Configured medical and pharmacy products for standard and custom groups.Analyzed and interpreted product selection and product changes, determined gaps between custom and standard benefits, considered system constraints, and proposed alternative solutions.Led pharmacy efforts with Express Scripts to improve the delivery timeliness and accuracy of pharmacy benefits to members resulting in a 30% increase in enrollment timing.Technical Support Specialist, Membership and Billing, September 2015 - September 2016Managed the real time escalation team implementing Washington State Exchange Enrollment and Membership.Utilized constructive coaching and feedback to develop employees skills and abilities, empowering them to make independent decisions in a highly chaotic environment.Collaborated with many teams to resolve OIC and OID complaints in a timely manner ensuring compliance.Appointed Liaison for all Washington State Tribal Sponsorships and approved third-party payers improving enrollment for a sensitive population by 80%.Senior Enrollment Analyst, Membership and Billing, June 2014 - August 2015Supported internal consultants and technical staff for premium adjustments and escalations.Responded to escalation pertaining to access to care in an urgent and concise manner.Backed up quality control due to exceeding quality and timeliness expectations.Enrollment Analyst, Membership and Billing, February 2014 - June 2014Enrolled, canceled, and updated members individual health plans on and off the Washington State Exchange with care and precision.United Healthcare, Bothell, WA September 1998 - April 2011Business Analyst, April 2001 - April 2011Managed multiple claims system re-platforms, upgrades, testing, and all system migrations. Led investigation and rebuttal efforts pertaining to State of Washington external audit findings.Researched and recommended improvement for all areas of business, introducing lean processes.Drafted business and system requirements for programming to improve auto adjudication and meet legal guidelines.Analyzed multiple systems to ensure accurate benefit administration across multiple departments.Tested benefit administration of all benefits pre and post implementation.Weighed cost versus benefit for system upgrades and improvements.Trained local hospitals on current and appropriate UB billing standards.Attended benefit fairs yearly to inform and educate members on their health insurance choices.Senior Claims Analyst, December 1999 - April 2001Processed all claim types, including COB, High Dollar, multiple surgery, retire benefits, adjustments, and refunds to ensure benefits were correct.Trained, audited, and provided technical support to claims analysts and medical review staff.Drafted new procedures and updated existing procedures.Exceeded production, quality, and timeliness goals.Customer Service Representative, September 1998 - December 1999Conducted inbound calls to address eligibility, benefits, and claim inquiries from members, provider, and other health insurance companies.Provided in person customer service to members that preferred to come into the office.Exceeded quality and production metrics.WWMG Western Washington Medical Group, Everett, WA June 1997 - September 1998Insurance Billing and Coding SpecialistBilled insurance companies in compliance with the law and specific to individual contracts. Coded claims accurately with CPT and ASA codes. Posted payments to patient accounts.Implemented testing and rolled out electronic billing platform.Developed and maintained procedure manual for all associates to utilize and ensure billing processes were standardized throughout all departments.Coded claims accurately and in compliance.EducationAssociate of Art (AA) CourseworkEverett Community College, Everett, WAPrerequisites for Nursing DegreeEverett Community College, Everett, WA |
