Alicia Hogan
Baton Rouge,Louisiana
Summary
Financial Operations Analyst with expertise in financial planning, analysis, and data management. Developed financial models that support decision-making and enhance financial performance through variance analysis and trend identification. Strong analytical skills combined with effective communication and strategic thinking. Demonstrated success in implementing strategies that boost profitability and operational efficiency.
Overview
15
15
years of professional experience
Work History
Financial Operations Analyst Lead
Carelon
07.2021 - Current
- Receives, validates and enters information in Finance System
- Adheres to maintained internal controls and tracking reports for reconciliation and analysis.
- Manage rigorous data validation, ensuring error-free financial reporting.
- Conducts independent analysis for purpose of resolving compiles and varied work process issues.
- Coordinates, manages and leads complex projects and processes.
- Documents and responds to any external audit requests.
Program Manager
Healthy Blue LA (Anthem, Inc)
07.2018 - 07.2021
- Manages and coordinates the process for Escalated Provider Complaints Operations Team (EPCOT).
- Ensures program meets all LDH stated objectives and requirements (SLAs).
- Researches complex claim issues and remain aware of industry trends.
- Manages relationships with partners, corporate and regional business areas to ensure that SLAs are being met.
- Evaluate clinical coding/coding combinations to help determine claim edit processing and rationale during the adjudication process.
- Used Medical Policies and Clinical UM Guidelines database to determine what medical services, procedures, devices and drugs may be eligible for coverage.
Program Administrator
Healthy Blue LA (Anthem, Inc)
02.2018 - 07.2018
- Investigates escalated provider claim, configuration and credentialing issues.
- Interact with providers to resolve complex issues.
- Assist and work LDH complaints related to complex provider issues.
- Assist in documentation and project status tracking.
- I plan and coordinate meetings between the providers and Health Plan for escalated complaints.
- Monitor and track activities to ensure objectives are met within established time frames.
Claims Resolution Analyst, Sr.
Healthy Blue LA (Anthem, Inc)
10.2015 - 02.2018
- Investigates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.
- Assists in the reviews of state or federal complaints related to claims.
- Work VIP appeals to determine appropriate resolution of issues within strict timelines.
- Interacts with Credentialing, Provider Relations Rep and Network Development, as well as network providers to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.
- Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.
- Work Encounter Report for the Health Plan for inaccuracies.
Network Operations Quality Auditor
AmeriHealth Caritas Louisiana
11.2013 - 10.2015
- Determine accuracy of claims by reviewing all items being audited according to the State Medicaid polices.
- Utilizes Medicaid applications necessary for audit including On-Line Help, and clinical edit system.
- Appropriately address inaccurate or questionable information related to the processing of claims audit.
- Researches, investigates and identifies trends or potential issues within the audit for QEP and ACA projects; Functioned as a Project Manager.
- Assist in running the Affordable Care Act project and Quality Enhancement program for the plan ensuring that goals are met.
- Analyze provider claims for correct Medicaid reimbursement.
Business Engineering Analyst
BlueCross BlueShield of Louisiana
12.2012 - 11.2013
- Responsible for the Post implementation of solutions which result in efficient, accurate and quality configuration and maintenance the company’s core and integrated system.
- Develops and maintains appropriate documentation to support identified issues.
- Train and develop other Analysts supporting the core or integrated system.
- Conducted Quality Assurance and Tested Medical claims and benefits in Quality Center for accurate configuration before products move to production for system implementation.
- Wrote test scenarios/cases from Business Requirements for Benefit Renewals and changes.
- Pulled Queries from SQL Database for validation of configuration changes.
Customer Service Learning Specialist
BlueCross BlueShield of Louisiana
07.2010 - 12.2012
- Train/Manage new hire Customer Service Advisors, as well as existing employees on Healthcare billing/claims and benefits.
- Design and develop training class responsive to the advisors needs.
- Insures appropriate, effective planning and implementation of training programs.
- Refresh current Advisors on changes of Benefits, Claims and Reimbursement.
- Trained Advisors on all Lines of Business: Corporate Accounts, Provider/Member Services, Federal and ITS.
Education
Master of Business Administration -
University of Phoenix
Baton Rouge, LA04.2009
Bachelor of Arts - General Business, Concentration in General Business, Minor in Management
Southeastern Louisiana University
Hammond, LA05.2006
Skills
- Organizational skills
- Effective communication
- Strategic planning and multitasking
- Goal-oriented mindset
- Strong work ethic
- Time management proficiency
- Detail-oriented approach
- Proficiency in MS Excel, Access, and SQL
- Expertise in financial reporting
- Project oversight
- Medical billing and claims management
- Data validation
Timeline
Financial Operations Analyst Lead
Carelon
07.2021 - Current
Program Manager
Healthy Blue LA (Anthem, Inc)
07.2018 - 07.2021
Program Administrator
Healthy Blue LA (Anthem, Inc)
02.2018 - 07.2018
Claims Resolution Analyst, Sr.
Healthy Blue LA (Anthem, Inc)
10.2015 - 02.2018
Network Operations Quality Auditor
AmeriHealth Caritas Louisiana
11.2013 - 10.2015
Business Engineering Analyst
BlueCross BlueShield of Louisiana
12.2012 - 11.2013
Customer Service Learning Specialist
BlueCross BlueShield of Louisiana
07.2010 - 12.2012
Master of Business Administration -
University of Phoenix
Bachelor of Arts - General Business, Concentration in General Business, Minor in Management
Southeastern Louisiana University
Similar Profiles
Rhey DuranRhey Duran
Community Health Worker at CarelonCommunity Health Worker at Carelon
Yasmine KamelYasmine Kamel
Hospitalist and SNF Attending at CarelonHospitalist and SNF Attending at Carelon
Sanjaya Kumar PatroSanjaya Kumar Patro
Scrum Master/Agile Project Manager at CarelonScrum Master/Agile Project Manager at Carelon
SHANDELL BROWNSHANDELL BROWN
Direct Service Worker at All Kare AlternativeDirect Service Worker at All Kare Alternative
Rachel OubreRachel Oubre
Community Assistant at Tailwind Group- Altitude Baton RougeCommunity Assistant at Tailwind Group- Altitude Baton Rouge