Alesha Green
Chesapeake,VA
Summary
Results-driven Healthcare Medicaid Project Manager with 15 years of experience in Medicaid, PBM, and provider operations. Specializes in project lifecycle management, Agile delivery, regulatory compliance, and risk management. Expertise in delivering complex healthcare implementations and driving large-scale organizational change initiatives, enhancing operational efficiency and business effectiveness.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Business Change Manager
Elevance Health - CarelonRx
Norfolk, VA
07.2021 - Current
- Manage projects of various sizes to implement new business and changes to existing operations sourced from state, federal and Health Plan regulations and decisions using Excel, Microsoft Project and Smartsheet
- Developed detailed project plans to monitor milestones and ensure successful, quality execution of deliverables.
- Facilitated kick-off and routine meetings to ensure progress tracking and alignment on Health Plan projects.
- Research State Documents to develop High Level Business Requirements to serve as a framework for Market Business Analysts to conduct interviews to define Detailed Business Requirements
- Coordinated with internal SMEs and leadership to identify defects, enhancing quality and consistency of outcomes.
- Coordinate, validate and report on quarterly and annual savings of the state mandated programs
- Coordinated with internal and external business to define mitigation and contingency plans to operational or project related defects.
- Coordinate with Developers to flesh out the approach to develop system logic for new reporting features
- Develop SharePoint based project sites to serve as a collaboration tool for projects documenting: Issues, Risks, Questions, Change Requests, Decisions and document repository for collaborating stakeholders
Network Data Specialist Lead
Anthem
Norfolk, VA
04.2016 - Current
- Identified and resolved errors in reimbursement, benefit, selection logic, provider data, and overall processing throughout claim life cycles to enhance claims accuracy.
- Facilitated communication between our technical team and Health Plan business partners, addressing escalated issues and gaps in claims processing operations.
- Made routine updates to claims selection logic improving the outcomes of claims payments to network providers.
- Utilized Access and SQL for daily reporting, backend updates, and claims analysis to ensure accurate data management.
- Trained associates on proprietary business applications using documented standard operating procedures to improve team proficiency.
Data Exchange Consultant
Agilon Health
Anaheim, CA
09.2020 - 07.2021
- Translated Business needs to actionable and testable requirements of data flows to track receipts of inbound data.
- Served as a liaison between internal and external technical departments to establish and test server connections; establish and maintain FTP Job Definitions
- Maintained and reported on over 1400 inbound file receipts.
- Created and maintained internal processing documents and assisted in training new associates on daily operational functions.
- Researched and resolved reported internal data gaps. Applications used in this role: Microsoft SQL Server, CORE (a company proprietary application), Axis, Microsoft Office Suite, File Zilla
Business Information Analyst Senior
Anthem
Norfolk, VA
10.2018 - 09.2020
- Using knowledge of provider data, claims adjudication, and provider reimbursement ran ad-hoc reports based on requirements from internal partners
- Performed data analysis through data creation and data manipulation of large sets of data using SQL and Excel.
- Lead cross functional meetings with internal-external partners ((IMO, NPC, Health Plan, PDX, APDO, Provider Architecture, and the State) to translate business needs into Business Requirements to implement new markets Medicaid Programs
- Requirements Documents and Business Technical Requirements resulting in provider directories, outbound Network Files and corresponding mapping documents.
- Created use cases for User Acceptance Testing as well as completed User Acceptance Testing (UAT) on system logic developed from the requirements.
Senior Reimbursement Analyst
Anthem
Norfolk, VA
08.2017 - 10.2018
- Conducted root-cause analysis of incorrect claims processing, leading to resolution of claims appeals and audits.
- Collaborated with internal partners to confirm findings and implement necessary fixes to benefit and pricing configurations.
- Executed impact analysis to identify market trends, prioritizing fixes and defining approaches for comprehensive systemic solutions during monthly meetings.
- The applications used in this role are: FACETS, Access, JIRA, SQL Developer, Webstrat, Optum Rate Manager, 3M, Pluto, Clear Quest, and Microsoft Office Suite
Provider Reimbursement Administrator
Anthem
Norfolk, VA
01.2014 - 04.2016
- Executed configuration set-up and maintained systems while collaborating with the Virginia market lead.
- Validated configuration changes to ensure claims processed according to reimbursement methodologies.
- Performed root cause analysis of claims payment errors and addressed issues for claims pending in the Business Configuration Department.
- Executed audits of provider agreement mapping to confirm accuracy of provider payments.
- Collaborated with senior analysts on data analysis, documentation, configuration, review, and testing for MD and VA markets.
- Executed queries to analyze provider and NetworX data to support informed decision-making.
- Trained lower-level analysts on pricing methodologies and GBD Facets functionality.
Configuration Analyst I
Amerigroup Corporation
Chesapeake, VA
11.2011 - 02.2014
- Processed provider contracts, assigned agreements to provider records, performed claims: research, resolution and adjudication
- Resolved internal IRU and Service Form requests in Macess and internal site of SharePoint.
- Ran reports and queries using ACCESS for massive provider updates.
- Prepared files for ART Tool backend loading process.
- Completed production only modification projects in ClearQuest.
- Analyzed incoming contracts to configure standard or custom agreements from state partners and other special projects
Accounts Payable Assistant
Amerigroup Corporation
Virginia Beach, VA
08.2009 - 11.2011
- Created and modified vendor records to ensure accuracy and reliability for payment processing.
- Maintained electronic and physical filing system in compliance with Record Information Management (RIM) policy for organized access to documents.
- Performed monthly file audits and ran reports for supporting documentation.
- Checked and distributed incoming mail to associates, facilitating timely provider setup and payments.
Provider Information Spec I
Amerigroup Corporation
Virginia Beach, VA
05.2006 - 08.2009
- Exceeded departments service level agreements by tracking and processing high volumes of providers’ contracts daily while recording data into several databases.
- Coordinated interactions between departments and clients, improving service delivery and ensuring alignment on provider information issues.
- Led weekly cross-functional conference calls with internal departments and health plan partners to facilitate collaboration and resolve provider-related queries.
- Researched and resolved system related or contractual issues pertaining to provider information, credentialing applications and pricing configuration.
- Assisted with special assignments in External (XC) Claims and Provider Data Management (PDM), processing large volumes of provider network rows and rosters to support data integrity.
Education
PMP -
Project Management Institute
06-2026
Bachelor of Arts - Healthcare Administration
Southern New Hampshire University
Online09-2021
Accounting - Accounting Major
Old Dominion University
Norfolk, VA01-2003
Skills
- Healthcare systems knowledge
- Change management expertise
- Business process improvement
- Regulatory compliance
- Requirements gathering and analysis
- Cross-functional team leadership
- Team leadership
- Claims processing
- SQL Server database management
- Toad for SQL development
- Smartsheet proficiency
- Process improvement strategies
- Excel spreadsheets
- Word processing
- Access databases
- Team collaboration
- SQL Server database management
- Data analysis techniques
- Change management
Certification And Professional Development
Certified Project Management Professional, PMI Institute, Completed Project Management Professional (PMP) ATP Bootcamp: 8 Day Cohort, 15 years of experience in project management, Anticipated exam date: 07/01/25
Certification
- Project Management Professional
Affiliations
- Community Support Organizer - BCOG Family Outreach
Timeline
Business Change Manager
Elevance Health - CarelonRx
07.2021 - Current
Data Exchange Consultant
Agilon Health
09.2020 - 07.2021
Business Information Analyst Senior
Anthem
10.2018 - 09.2020
Senior Reimbursement Analyst
Anthem
08.2017 - 10.2018
Network Data Specialist Lead
Anthem
04.2016 - Current
Provider Reimbursement Administrator
Anthem
01.2014 - 04.2016
Configuration Analyst I
Amerigroup Corporation
11.2011 - 02.2014
Accounts Payable Assistant
Amerigroup Corporation
08.2009 - 11.2011
Provider Information Spec I
Amerigroup Corporation
05.2006 - 08.2009
PMP -
Project Management Institute
Bachelor of Arts - Healthcare Administration
Southern New Hampshire University
Accounting - Accounting Major
Old Dominion University