Angela Jones, MHA
Summary
Experienced business systems professional committed to streamlining processes and enhancing system efficiency. Known for fostering team synergy and delivering measurable results in dynamic environments. Skilled in business analysis, data modeling, and project management. Adaptable and dependable, consistently meeting evolving organizational needs to drive successful outcomes.
Overview
14
14
years of professional experience
Work History
Senior Business Systems Analyst
Lyric
09.2019 - Current
- Effectively work as customer-facing ClaimsXten rules development consultant that provides software expertise to assigned client base for successful client implementations, upgrades, and on-going production support use of the software.
- Triage, troubleshoot, and problem-solve for rule and non-rule issues reported during implementation and upgrade projects, Go Live, and post Go Live production support.
- Guide customers through impacts for routine CXT content and rule updates. Work with Medicare, Medicaid, and Commercial lines of business.
- Consult on rule development for customer intent, gathering and documenting technical requirements, troubleshooting rule behavior, testing rule functions, supporting QA testing, defect remediation, managing Pivotal (CRM), JIRA, CRB, and other methodology processes.
- Effectively participates in ClaimsXten Service Delivery Team meetings, initiatives, and metrics.
- Achieved successful system deployments by coordinating cross-functional teams throughout all stages of development.
- Developed customized reports, meeting specific department needs while ensuring data accuracy and accessibility.
- Managed complex projects from inception to completion, ensuring timely delivery within budget constraints.
- Spearheaded system upgrades to enhance user experience and improve overall functionality.
- Collaborated with stakeholders to gather requirements, translating them into actionable plans for system improvements.
- Championed change management initiatives during major software transitions, effectively managing stakeholder expectations while minimizing disruptions to daily operations.
- Leveraged automation tools to streamline manual tasks, increasing staff efficiency and reducing errors in critical business processes.
- Provided expert-level support to end-users in troubleshooting technical issues, promoting a positive user experience across various business functions.
- Conducted comprehensive testing processes for quality assurance, minimizing post-deployment issues and improving end-user satisfaction.
Senior Business Systems Analyst
ClaimsXten Portfolio- (now Lyric)
01.2019 - 09.2019
- Effectively work as customer-facing ClaimsXten rules development resource for successful client implementations, upgrades, and on-going production support use of the software.
- Triage, troubleshoot, and problem-solve for rule and non-rule issues reported during implementation and upgrade projects, Go Live, and post Go Live production support. Built custom policies for customer which is equivalent to building rate sheets in claims configuration system, and 5 years experience assisting with pricing for codes.
- Guide customers through impacts for routine CXT content and rule updates. Work with Medicare, Medicaid, and Commercial lines of business.
- Consult on rule development for customer intent, gathering and documenting technical requirements, troubleshooting rule behavior, testing rule functions, supporting QA testing, defect remediation, managing Pivotal (CRM), JIRA, CRB, and other methodology processes.
- Effectively participates in ClaimsXten Service Delivery Team meetings, initiatives, and metrics.
- Functions as a team member in support of all goals and objectives.
- Ensure high quality, on-time client deliveries with assigned Service Delivery Team on a monthly basis, as well as team collaboration with offshore resources.
- Effectively support internal special projects for the purposes of evaluating, improving, correcting, or newly implementing initiatives, objectives, new feature functions, defect remediations.
- Provide forecasting and/or pricing for level of effort for new or existing rule work for upcoming projects and supply requested metrics during team meetings.
- Work with the Engagement manager and Staff Payment Accuracy Advisors to determine internal project milestones to drive client deliveries.
Business Analyst II
Centene Corporation
10.2018 - 08.2019
- Perform analysis and interpretation to link business needs and objectives for assigned function within the Medicaid framework.
- Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems via SQL servers.
- Identify and analyze user requirements, procedures, and problems to improve existing processes.
- Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation.
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Developed high-quality documentation to support training efforts, helping employees fully understand new systems and procedures.
- Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
- Improved business processes by analyzing current practices and recommending optimization strategies.
- Optimized workflow processes to enhance overall productivity and achieve operational excellence.
Planner Supervisor
Department of Behavioral Health & Developmental Disabilities (DBHDD)
10.2016 - 10.2018
- Supervise the work assignments of subordinate staff.
- Supervise policy development, modification, implementation, and evaluation in an assigned specialty area.
- Analyze and make recommendations on proposed legislation to determine potential effects on the assigned department or program area(s).
- Utilize clinical knowledge and background, and information from various other sources to inform planning for policy development. Monitoring business processes and opportunities for streamlining, improving communications, and measuring performance. Served as the primary point of contact on all tasks that involve integration of policy.
- Prepare reports and presentations, drafting agenda items and background materials and works with clients, outside vendors, and Sr. management to develop or implement programs in a manner that addresses division/department strategies.
- Assist with implementation of Hospital Policy Improvement Plan to achieve improved hospital services.
- Manage and coordinate new and existing DBHDD policies ensuring that needed policies are developed and maintained for hospitals, community providers and DBHDD staff.
- Coordinate interaction between department, agency and facility operating units, other programs and/or external customers as appropriate to accomplish policy management.
- Initiate, conduct and facilitate workgroups regarding the development, review, revision, interpretation and/or implementation of policies, procedures, standards and guidelines.
- Disseminate policies to intended audiences.
- Review training regarding policies as requested by Training staff.
- Coordinate compliance with rules, regulations and external policies within existing resources and under the direction of DBHDD Clinical and Administrative leadership.
Revenue Cycle Process Operations and Standardization
Fresenius Medical Care
02.2016 - 06.2016
- Responsible for driving process improvement/ re-design initiatives including system implementation and re-engineering.
- Collaborated across the Revenue Cycle Organization, corporate, legal, compliance, and the revenue centers to handle a wide array of monthly and yearly financials, preparation of budgets and 1099s.
- Provided support through development of workflows/process flows, analytics, and communication material.
- Collaborated with SMEs, Revenue Center employees, and Revenue Cycle Transformation Program to document end-to-end processes regarding financials into fully functional procedures to be used across the revenue cycle.
- Analyzed and made recommendations on all facets of the revenue management framework.
- Worked closely with the Revenue Cycle Program team leaders to support process re-design through analytics, research, and presentation development.
- Collaborated with legal, compliance, corporate and Revenue Cycle Program to identify improvements or changes to be adopted across the revenue cycle in accordance with Sarbanes-Oxley (SOX) requirements.
- Forecast profit and loss for the company, performed cash flow analysis and created annual budgets for multiple departments across the Revenue Centers.
- Facilitated review and feedback of draft policy and procedures from divisional leadership, internal controls, legal and other applicable parties on all new policies and procedures through Survey Monkey.
Senior Financial Analyst
Morneau Shepell
12.2014 - 12.2015
- Responsible for conducting batch invoice billing initiation and quality review checks.
- Designed and reviewed individual account billing reconciliation on a daily, monthly, weekly basis.
- Updated daily lockbox imports, EFT transfers.
- Analyzed and made recommendations on current and past financial performance which included large data sets and presented data to leadership through VLOOKUP and Pivot Tables.
- Gathered financial and benchmark information and data and performed analysis to establish baseline and determined present/future financial performance.
- Developed ad-hoc financial analyses as required for financial modeling, forecasted profit and loss for the entire client's book of business, performed cash flow analysis and created annual budgets for multiple departments.
- Worked with the Salesforce CPQ software program and Microsoft Dynamics GP to analyze financial and business operating results.
- Developed and maintained dashboards and reports for internal financial reporting.
- Prepared and distributed analysis and reports to senior leadership and all operational areas.
- Performed revenue and expense forecasts (projected income statements, balance sheets, and cash flows).
- Recommended financial actions by assessing options in relation to organization goals.
- Performed a variety of accounts payable/accounts receivables duties including payment processing, payment allocations, and collection notifications.
- Processed daily ACH file exports.
- Reviewed, approved, and processed member refunds via check & ACH through Microsoft Great Plains software.
- Generated and reviewed aging reports distributed from SQL queries.
- Initiate and complete projects independently and as a team member.
- Reported daily bank cash position to team lead/ manager and other ad-hoc treasury reports.
- Analyzed and processed terminations for non-payment.
- Processed monthly commissions for brokers.
Claims Resolution Specialist
eLab Solutions
06.2013 - 08.2013
- Processed all payments from claims and applied those payments against invoices.
- Reconciled accounts to balance accounts and clear exceptions.
- Worked with Salesforce CRM software to integrate the functions of sales, analytics, IT, and marketing support.
- Researched and resolved discrepancies between bank postings and payment files to ensure correct payments and allocation.
- Achieved high customer satisfaction ratings by providing prompt, empathetic, and accurate resolutions to claims.
- Assisted in the development of new policies and procedures based on emerging industry trends or regulatory changes.
Physician Denial Management Specialist
Northside Hospital
08.2011 - 06.2013
- Researched and analyzed denial data and coordinated denial recovery responsibilities.
- Identified, analyzed, and researched frequent root causes of claim denials and developed corrective action plans for resolution of denials.
- Developed reporting tools that effectively measured and monitored processes throughout the denials management process in order to support process improvement.
- Prioritized activities to work overturns in a timely manner to alleviate untimely claim filings.
- Used reports that categorized denials to assign tasks or personally work to overturn denials.
- Identified and pursued opportunities for improvements in denial performance; assisted with chart audits, processed work lists to facilitate prompt intervention of insurance denials.
Education
Master of Arts - Healthcare Administration
Walden University
06-2017
Bachelor of Science - Sociology
Georgia College & State University
12.2007
Skills
- User acceptance testing
- Process mapping
- Project management
- Release planning
- Business documentation
- Systems analysis
- Data analysis
- Medicare/Medicaid Knowledge
- Client Training & Support
- Strategic Leadership
- Application support
- Business intelligence tools
- Requirements gathering
Technical Applications
MS PowerPoint
MS Excel
MS Visio
MS Word
MS Outlook
JIRA
Sharepoint
RemedyForce
Confluence
Awards & Honors
Recipient of the Spotlight Award 2022-2025
Timeline
Senior Business Systems Analyst
Lyric
09.2019 - Current
Senior Business Systems Analyst
ClaimsXten Portfolio- (now Lyric)
01.2019 - 09.2019
Business Analyst II
Centene Corporation
10.2018 - 08.2019
Planner Supervisor
Department of Behavioral Health & Developmental Disabilities (DBHDD)
10.2016 - 10.2018
Revenue Cycle Process Operations and Standardization
Fresenius Medical Care
02.2016 - 06.2016
Senior Financial Analyst
Morneau Shepell
12.2014 - 12.2015
Claims Resolution Specialist
eLab Solutions
06.2013 - 08.2013
Physician Denial Management Specialist
Northside Hospital
08.2011 - 06.2013
Master of Arts - Healthcare Administration
Walden University
Bachelor of Science - Sociology
Georgia College & State University
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