ASHLEY CRUZ
Boise,Idaho
Summary
Results-driven Configuration Analyst optimizing system performance and streamlining workflows. Proficient in proposing, testing, and troubleshooting system transitions. Exceptional organizational abilities and proactive approach to managing multiple priorities. Collaborates effectively with stakeholders to align technology solutions with business needs.
Overview
11
11
years of professional experience
Work History
Configuration Analyst
Blue Cross Of Idaho
Meridian, ID
04.2022 - Current
- Configured Facets tables and applications to enhance claims accuracy and efficiency.
- Managed and coordinated the Releases and Implementation of Interplan Teleprocessing (ITS/Bluecard) to ensure seamless transitions.
- Conducted research, analysis, and documentation of business requirements and functional specifications for various projects.
- Delivered clear and detailed documentation, improving project clarity and stakeholder understanding between business stakeholders and the development team.
- Communicated business needs and validated solutions with stakeholders, ensuring alignment with business objectives.
- Effectively established understanding of business requirements with team members for implementation of functional demands.
- Contributed to the validation of complex documents in support of claims processes for final versions.
- Executed and coordinated business user acceptance, regression testing, peer review, and associated test initiatives.
- Designed thorough test plans and scripts aimed at resolving post-deployment defects.
- Played a key role in the Claims Automation Project by coordinating vendor (HPA/Sagility) work, executing thorough testing procedures,and overseeing effective implementation.
- Enhanced compliance by developing scripts, reports, analytics, and efficient processes.
- Developed efficient MSSQL queries to handle Retro Adjustment tickets involving updates and changes in provider contracts, pricing, and product information.
- Inter Plan Projects, including Bluecard Modernization, with direct project work in Real-Time Messaging implementation.
- Analyzed existing systems and databases, and recommended enhancements to solve business needs.
Operation Specialist
BlueCross Of Idaho
08.2021 - 04.2022
- Managed and resolved complex claim inquiries with prompt resolutions.
- Maintained claims inventory and metrics for Interplan Scorecard measures
- Provided administrative support to over 20 staff members by overseeing examiner duties, training, and other department functionalities.
- Conducted reports and analysis of data to provide process improvement to my team.
- Assisted in meeting changing demands by suggesting enhancements to business systems or procedures.
- Developed effective improvement plans in alignment with performance goals and specifications.
- Evaluated customer needs and feedback to drive product and service improvements.
- Devised and implemented processes and procedures to streamline operations.
- Generated reports detailing findings and recommendations.
- Evaluated staff performance and provided coaching to address inefficiencies.
CLAIMS EXAMINER II
BlueCross of Idaho
05.2019 - 08.2021
- Processed general/complex Bluecard medical claims.
- Resolution processing of claim adjustments, inquiries, and other Plan to Plan inquiries.
- Provided training and support with other examiner staff.
- Responsible for inventory reports and other area reports for the department.
Claims Examiner I
Blue Cross Of Idaho
Meridian, ID
11.2018 - 05.2019
- Processing ITS Home claims
- Identify any claims issues, e.g. benefits, pricing etc.
- Assisted in claims documentation and training
- Generated inquiries to Host plans
MEDICAL BILLING ASSOCIATE
FHP Health Center
08.2013 - 09.2018
- Oversaw the processing of medical claims for multi-specialty services by reviewing, preparing and submitting them accurately after verifying benefits, coverage and obtaining pre-certifications.
- Delivered accurate accounts receivable reports to billing supervisor/manager, actively following up on outstanding payments.
- Implemented effective use of billing practices and coding guidelines
- Audit medical records and claims to ensure proper billing practices, validate accuracy of charges, patient diagnosis, and coding edits.
- Ensured profitability by reconciling oncology drug reimbursement with pharmacy department requisition.
- Resolved coding errors by working directly with providers and staff members.
- Developed strategies to improve collection efforts of outstanding balances due from payers.
- Submitted appeals using provider portals and phone communication.
Education
High School Diploma -
John F Kennedy High School
Tamuning, Guam06.2008
Currently Enrolled - Project Management Certification
Syracuse University
Syracuse, NYSkills
- MS Office: Word/Excel/Note
- Business Process and Workflow Automation
- SQL Data Querying and Reporting
- Team Training and Development
- Change Management Process
- Product Release and Development
- User Acceptance Testing (UAT)
- Project Management / Planning
- Root Cause Analysis
References
Amy Guerra
Manager Service Operations | BlueCross of Idaho
(986) 224-5168
Jodi Marshall
Director, InterPlan Relations | BlueCross of Idaho
(425) 736-5534
Timeline
Configuration Analyst
Blue Cross Of Idaho
04.2022 - Current
Operation Specialist
BlueCross Of Idaho
08.2021 - 04.2022
CLAIMS EXAMINER II
BlueCross of Idaho
05.2019 - 08.2021
Claims Examiner I
Blue Cross Of Idaho
11.2018 - 05.2019
MEDICAL BILLING ASSOCIATE
FHP Health Center
08.2013 - 09.2018
High School Diploma -
John F Kennedy High School
Currently Enrolled - Project Management Certification
Syracuse University