Hi, I’m
Alison Klinkhammer
Salem,South Dakota
Summary
In-depth Quality Assurance Specialist with success in prioritization and multitasking. Exceptional communication and organizational skills. Committed to paying impeccable attention to reviews and auditing procedures.
Overview
21
years of professional experience
Work History
Sanford Health Plan
Senior Quality Assurance Specialist
10.2016 - Current
Job overview
- Responsible for the coordination and management of operational projects related to and resulting from organizational change.
- Collaborated with management and department level subject matter experts (SMEs) to operationalize, communicate, and assist in implementation of new business directives and regulatory requirements.
- Engaged in ongoing and continuous process improvement and workflow engineering, in close collaboration with management and SMEs.
- Analyzed and implemented operational processes/workflows, policies and standard operating procedures to ensure that operations align with organizational knowledge documentation.
- Worked strategically with regulatory and implementations teams and others to determine the internal impact of regulatory changes, coverage mandates, including state, patient protection and affordable care act (PPACA), employee retirement income security act (ERISA), essential health benefits (EHB), and business/operational philosophy changes
- Acted as an interdepartmental liaison, working in tandem with other technical and operational (department) peers and team members within the Sanford Health Plan (SHP), to tackle complex problems requiring multiple viewpoints to develop solution alternatives.
- Assisted management and teams as an agent of change by thorough analysis, documentation, consensus building, and communication with end-users and internal stakeholders.
- Developed policy documents, and maintain manage revision and review processes for all operational departments and software workflows, in collaboration with management.
- Analyzed claim data to discover areas where the health plan can improve claims processing and eliminate manual workflows where possible, or finding areas were workflows need to be modified so that claims are processed correctly.
- Resource to the all Operations and Utilization Management Departments regarding claim adjudication
- Configured the Epic Tapestry system to correctly process member claims according to their plan benefits as defined by their plan documents
- Optimized the benefits build so that it can be done as quickly and as efficiently as possible, which led to being asked to present at UGM regarding the processes we’ve put in place
- Lead architect for the new year benefits build which has led to our build process improving from one year to the next
- Problem solved any issues regarding how claims processed, and worked with other departments by explaining what will happen if a change they’re proposing were to occur
Sanford Health Plan
Claims Team Lead
09.2015 - 09.2016
Job overview
- Resource to the Claims Department team members when they were in need of assistance in processing of a claim.
- Developed the first resource of workflows for claims processing.
- Department contact for the implementation of the claims data scanning project, which was put in to affect in March, 2016.
- Contributed to the development of the new DRG validation project, which was implemented in May, 2016.
- Contributed to the development of the APC contracting project, which began implementation in July, 2016.
- Assisted in the development of the North Dakota Public Employees Retirement System plan implementation, and the processing of their claims.
- Worked on discovering ways the Health Plan Claims Department could operate more efficiently and accurately, by identifying shortfalls and how we could improve on making them better.
- The Claims Department contact for other Health Plan departments when they are in need of claims processing expertise.
Sanford Health Plan
Insurance Claims Specialist
03.2007 - 09.2015
Job overview
- Main processor of claims, including institutional and professional, coordination of benefits and subrogation claims.
- Assigned special projects when issues occur and claims or member accumulators need to be adjusted
- Created spreadsheets in Excel for various members of the claims department when they are in need of a document to track various Health Plan projects and issues
- 99.99% accuracy rate over 7 plus years for the Health Plan
Sioux Falls Flying J
Bookkeeper/Shift supervisor/Cashier
07.2008 - 09.2008
Job overview
- Balanced cash on hand with general ledger, reconciled general ledger accounts, processed company deposits, interacted with customers.
Great Western Bank
Teller
08.2006 - 10.2006
Job overview
- Greeted customers and answered phones
- Assisted customers with bank transactions
First Dakota National Bank
Proof Reader/Sorter Operator
07.2005 - 08.2006
Job overview
- Balanced the daily work of the tellers, and made the daily deposit for the bank
- Researched and corrected processing errors for customer accounts
Sioux Falls Flying J
Bookkeeper/Shift supervisor/Cashier
06.2004 - 08.2005
Job overview
- Balanced cash on hand with general ledger, reconciled general ledger accounts, processed company deposits
- Managerial duties included resolving customer service issues, employee management, problem solving, resolving crisis situations
First Dakota National Bank
Loan Secretary
01.2002 - 08.2002
Job overview
- Performed administrative tasks while assisting supervisors and peers
Education
University of South Dakota
Bachelor of Business Administration from Accounting, Legal Studies
University Overview
GPA: 3.2, GPA: 0
Skills
- Quality Assurance
- Sound Decision-Making Abilities
- Compliance
- Customer Service
- Process Improvements
- Problem-Solving Skills
- Performance Testing
- Verbal Communication Skills
- Quality Improvement
- Analytical Thinking
- Team Member Development
- Internal Audits
Timeline
Senior Quality Assurance Specialist
Sanford Health Plan
10.2016 - Current
Claims Team Lead
Sanford Health Plan
09.2015 - 09.2016
Bookkeeper/Shift supervisor/Cashier
Sioux Falls Flying J
07.2008 - 09.2008
Insurance Claims Specialist
Sanford Health Plan
03.2007 - 09.2015
Teller
Great Western Bank
08.2006 - 10.2006
Proof Reader/Sorter Operator
First Dakota National Bank
07.2005 - 08.2006
Bookkeeper/Shift supervisor/Cashier
Sioux Falls Flying J
06.2004 - 08.2005
Loan Secretary
First Dakota National Bank
01.2002 - 08.2002
University of South Dakota
Bachelor of Business Administration from Accounting, Legal Studies
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