AUTUMN HARRIS
Riverview,FL
Summary
Multi-faced Medical Analytical professional with superior communication skills. 4+years of expertise in various healthcare technical platforms. Adapts well to the shifting of business needs in a systematic and effective way. Exceptional performance driven individual ready to obtain an opportunity that provides the professional platform to showcase my robust skillset and excel for continuous success by utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
10
10
years of professional experience
Work History
Business Systems Configuration Analyst I
Convergys
02.2023 - 04.2024
- Delegates the process of import & export for provider agreements data load and validation.
- Adheres to best practices for claims analysis, data migration, defect updates, and unit testing, to ensure quality and consistency.
- Utilizes Facets configuration and effective communication to implement workflow functions within required guidelines
- Performs technical analysis through SQL queries and unit testing (UAT) within Facets to emit Business & Pricing standards
- Implements negotiation meetings with stakeholders for contracts to support network pricing rules and methodologies on reimbursement rates
- Prepares CM-related documentation for effective delivery during Scrum meetings
Provider Credentialing Liaison
Vangent
01.2022 - 12.2022
- Responsible for processing provider applications, credentialing/re-credentialing and primary source verification of providers (Commercial/Tricare accounts).
- Audited provider CAQH records and verified that all pertinent elements are captured in the databases accurately
- Maintained provider information in online credentialing databases and systems Cactus, OmniFlow & Xcelys
- Reviewed provider/ facility application data to ensure professional affiliations, licensure meets the proposed requirements for timely renewals
Sr. Configuration Analyst
Bank Of America
12.2019 - 06.2020
- Evaluated configuration testing, fee schedules, price rules, payable PT codes within the following databases Facets, QNXT and Diamond
- Created Rules within Paradigm System, in coordination within State and CMS guidelines for claims adjudication
- Performed unit testing in various environments for Payment Methodologies related to rates in Networx pricing
- Enhanced business requirements and maintained CM work aligned with prospective configuration management plan
- Conducted thorough analytical review of pricing models attached to perspective Lines of Business and Provider Contracts
Claims Auditor
Bank Of America
12.2017 - 12.2019
- Researched issues related to claims processing to identify origins and implement corrective solutions
- Provided high-level professionalism when responding to emails to promote company's dedication to service
- Reviewed new files to determine current status of claim payment and or adjudication
- Collaborated with claims department to resolve complex claims.
Sr. Claims Analyst
Bank Of America
12.2013 - 12.2017
- Determined coverage outlined in benefits description and assessed documentation from healthcare providers to delegate responsibility of claim appropriately
- Reviewed questionable claims by conducting analytical approach to resolve claim effectively
- Identified error payments for denial and pay codes to allocate to correct teams
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
Education
Bachelor of Science - Medical Social Work
Florida Agricultural And Mechanical University
Tallahassee, FL08.2013
Skills
- Credentialing
- Benefits Configuration
- Claims Editing (CES)
- Xcelys
- Project Management
- Facets
- Case management
- Provider Implementation
Affiliations
- Delta Sigma Theta Sorority Inc.
Timeline
Business Systems Configuration Analyst I
Convergys
02.2023 - 04.2024
Provider Credentialing Liaison
Vangent
01.2022 - 12.2022
Sr. Configuration Analyst
Bank Of America
12.2019 - 06.2020
Claims Auditor
Bank Of America
12.2017 - 12.2019
Sr. Claims Analyst
Bank Of America
12.2013 - 12.2017
Bachelor of Science - Medical Social Work
Florida Agricultural And Mechanical University