Summary
Overview
Work History
Education
Skills
Timeline
Generic

Brenda L. Parker

Evanston ,IL

Summary

With over 20 years experience within the highly regulated Healthcare and Health Insurance industries. Experience developing project charters, detailed plans, communication strategies, and risk management plans. Well-versed in healthcare insurance process and regulations, including vendor and product contracts including review, credentialing, negotiations, and filings. Participates in requirements gathering sessions and working with Project Managers to translate and determine project scope. Experience conducting audits to support business goals; assessing system fixes to identify and resolve issues with a focus on risk. Works with complex workflows or workgroups, demonstrating a high level of skill developing and creating detailed work plans, timelines, and other appropriate documentation. Experience in the complete cycle of application change management. Hands on experience analyzing data, performing calculations, identifying, and resolving key barriers/problems. Well versed in workflows and developing system support, including analysis of business needs and user needs, translation into proper system requirement specifications and documentation of requirements. Excellent communication skills with a highly process-driven demeanor.

Currently, serve as a HCSC Compliance Ambassador .

Overview

26
26
years of professional experience

Work History

Strategic Consultant Lead

The Dearborn Group; HCSC
01.2022 - Current
  • Lead larger scale or enterprise-wide level engagement teams and complex projects that cross multiple business units while problem-solving difficult challenges with known and unknown solutions
  • Work independently to partner with business leaders and teams to scope, define and coordinate initiatives in support of business innovation and strategy
  • Serve as an internal consultant to department leaders on the development and refinement of strategic plans
  • Develop and communicate corporate-level strategies and innovation opportunities to executives that may include new business opportunities and competitive positioning
  • Lead market analysis initiatives targeted to drive growth
  • Develop and refine performance measures and internal/external benchmarks to develop an information framework that supports desired business outcomes
  • Develop complex financial and investment models and prepare ROI analysis for ASC team members and senior management while demonstrating thought leadership, innovative tendencies, and an ability to execute on strategy
  • Facilitate large cross-functional working sessions or meetings to align strategy and plan
  • Other duties may evolve and be assigned.

Business Application Analyst

Lurie Children's Hospital
01.2019 - 06.2021
  • Supports information management needs of various client departments or workflows across the organization through project coordination, applications implementation, upgrades, and ongoing maintenance or enhancements
  • Other duties include:
  • Manages small and medium sized projects as well as mentors less experienced staff
  • Adheres to HIPAA regulations for transactions, security, and confidentiality
  • Provides application implementation support, technical guidance, and serves as primary resolution point for all issues regarding assigned applications
  • Works with complex workflows or workgroups, demonstrating knowledge of integrated workflows and applications and problem analysis to provide system solutions for organizational needs
  • Works collaboratively with end-users to understand workflows and develop system support, including analysis of business needs and user needs, translation into proper system requirement specifications and documentation of requirements
  • Manages small to medium-sized assigned projects or phases of a larger project, with minimal supervision
  • Develops and creates detailed work plans, timelines, and other appropriate documentation
  • Identifies appropriate resources needed and provides timely status reports
  • Provides data transfer, access, and manipulation of aggregate and comparative data
  • Aid with system selection, system maintenance/upgrade and implementation, including system definition, build, testing and conversion planning and interfaces
  • Develops and monitors testing scenarios and methodologies to demonstrate system effectiveness
  • Prepare and maintains documentation on testing plans
  • Participates in completion of user documentation and training procedures
  • Evaluates system utilization and performance
  • Participates in system optimization.

Vendor Credentialing Specialist

Arjo, INC
07.2017 - 01.2019
  • The Vendor Credentialing Specialist is part of the HR team and serves as main point of contact and liaison between vendors, hospitals, and field sales and service for routine and unusual credentialing requests and contracts
  • The position is responsible for maintaining current knowledge of credentialing policy and procedures and ensuring internal compliance
  • This position also manages and maintains credentialing files and training databases
  • Serve as main point of contact for credentialing and contracted healthcare vendors
  • Other duties included:
  • Ensure all six hundred-field sales and service employees maintain current credential requirements for vendors entering hospitals and other customer accounts
  • Coordinate with hospital administrators and credentialing companies to resolve unusual credentialing requests and resolve any other complex issues
  • Monitor and ensure compliance with company policies and procedures to align with federal and state law and hospital credentialing policies
  • Train new sales representatives and service employees on the vendor credentialing process
  • Manage the learning management system to ensure all employees are registered for mandatory new hire and annual training requirements and the suite of courses needed for vendor credentialing
  • Maintain the online library of available courses
  • Plans, configures, and installs critical line-of-business applications such as Electronic Resource Planning (ERP) and Business Intelligence (BI) systems
  • Maintains application access, sets up appropriate accounts following established procedures, and delete obsolete accounts to ensure application security
  • Monitors application performance, storage requirements, and disaster recovery procedures to ensure maximum application availability.

Contracting Coordinator

DaVita
12.2015 - 02.2017
  • The Credentialing & Contracting Coordinator manage daily functions of the credentialing and re-credentialing process for physicians, vascular access centers, and ambulatory surgery centers
  • The provider enrollment process involves requesting enrollment/contracting with a plan; completing the plans credentialing/enrollment application; submitting copies of licenses, insurance, and other documents; signing a contract; and any other steps that may be unique to a carrier
  • When receiving a provider enrollment request, health plans use the credentialing processes to ensure that the provider is properly educated, trained, and meet any other specific insurance network enrollment requirements for participation
  • After credentialing process is complete, then the network will offer a contract for participation to the provider
  • Other duties included:
  • Drives successful credentialing and re-credentialing through management of designated portfolio, including existing centers, new centers, and center development
  • Works collaboratively with Directors of Contracting to ensure all providers credentialed with contracted third-party payors
  • Work with Director of Contracting with responds to complex inquiries regarding contract obligations and revisions
  • Manages day-to-day activities related to the credentialing and re-credentialing of Vascular Access Centers
  • Coordinates and process initial credentialing, re-credentialing, and special requests; provide status updates to Management, Physicians, Center Managers, and Practice Managers of any updates including Medicare and Medicaid
  • Follow-up to obtain network participation status from Insurance payors
  • Complete applications and assemble documentation as required by the Insurance payors
  • Reviews and tracks request to add/remove or update physicians from health plans within the assigned divisions
  • Utilizes electronic SharePoint database access for provider enrollment and demographic updates to promote timely processing and provider network inclusion
  • Keep updates of all detail of provider information in Excel, Microsoft Office Tools
  • Processes requests to add/remove practitioners to/from facilities, including active management through completion
  • Complete applications and assemble documentation as required by the Health Plan
  • Updates CAQH, PECOS and NPPES Registry and other applicable databases
  • Oversee initial and complex credentialing requirements discussions with entities, physicians, and agencies both internal and external
  • Enters, updates, tracks and monitors information in the medical software database
  • Aid with system selection, system maintenance/upgrade and implementation, including system definition, build, testing and conversion planning and interfaces
  • Develops and monitors testing scenarios and methodologies to demonstrate system effectiveness
  • Prepares and maintains documentation on testing plans
  • Participate in completion of user documentation and training procedures
  • Evaluates system utilization and performance
  • Participates in system optimization
  • Work with the Reimbursement Billing Dept
  • Or Practice Managers to get proper documents to credential physician using payor web portals
  • Manage, create, and execute EFT, ERA and gather all billing entities for the Insurance payors
  • Manage and complete W9 workflow processes and house W9 in centralized location
  • Identifies risks and issues, suggest alternatives that lead to the best solutions.

Provider

Land of Lincoln Health Insurance
12.2014 - 05.2015
  • Responsible for entering and maintaining demographic and credentialing data for all healthcare provider types using the provider data management (PDM) system
  • Responsible for processing provider rosters, adds, changes and all forms of demographic changes
  • Produce reports of system data for management, providers, internal staff, and other users
  • Develop relationship with vendors, customers and addressing their needs
  • Responsible for contributing to the Monthly Project Management Reviews (PMR), IT ExCom and other board reviews, coordinating and monitoring the project schedule to ensure customer business requirements are met
  • Other duties included:
  • Collaborate with IT professionals as an ambassador of change and supports process improvement throughout the system
  • Estimate, coordinate, and oversee multiple concurrent projects and milestones, often involving large and/or multi-department teams
  • Installed cases and submitted approval forms for appeal process
  • Conducts claims audits, support business goals, system fixes when analyzing, identifying, and resolving issues
  • Develops and disseminates written/policies/procedures and guidelines
  • Assist with Recruiting opportunities
  • Maintain confidential files on all provider applications and other supporting documents including uploading documents in SharePoint
  • Keep updates of all detail of provider information in Excel, Microsoft Office Tools develops and monitors testing scenarios and methodologies to demonstrate system effectiveness
  • Prepares and maintains documentation on testing plans
  • Participate in completion of user documentation and training procedures
  • Evaluates system utilization and performance
  • Projects encompass business, clinical and other technological initiatives
  • Develop project charters, detailed plans, communication strategies, and risk management plans
  • Process electronic rosters from providers
  • Communicate with Network Development Director and Account Management as needed regarding contract workflow
  • Load provider demographic data into PDM
  • Proofread and corrects documents, memos, and letters
  • Analyze Provider Contracts from Contractor Management
  • Work with third party vendors on use of data configurations and policy
  • UAT testing.

Information Database Assistant

Illinois State Medical Society
07.2014 - 12.2014
  • Promote retention and recruitment efforts through the maintenance and enhancement of the existing member database information, as well as potential member and policyholder databases
  • Provides support to projects in relationship to physician practice data
  • The responsibilities involve analytical support of the Director and quality consultants/analysts in benchmarking and process improvement initiatives, calculation of department and facility-level statistics, and database management
  • Project workload includes data collection, data analysis, database maintenance, report production, documentation, presentation, and file organization
  • Work in relationship with The American Medical Association
  • Other duties included:
  • Enhance, maintain, and update the physician member and non-member database records in iMIS system
  • Develop and maintain physician hospital medical staff lists and group rosters
  • Ongoing basis interacting with various internal departments, as well as external sources
  • Research and verify physician board certification
  • Work with AMA to get unique identification information for physicians
  • Analyze and correct data
  • Responsible for detailed analysis and documentation of business requirements and aligning the business requirements with technical solutions
  • Responsible for creation of user acceptance testing documentation and training procedures for multiple simultaneous projects for an imaging application
  • Document solution design, testing, training, and supporting users, working with the customer and software vendor as necessary to troubleshoot software issues
  • Analyze technical requirements for data warehousing and business informatics systems development
  • Work in tandem with county medical societies to provide appropriate datasets and reports
  • Assist the department Director and the division Vice President as needed
  • Keep updates of all detail of provider information in Excel, Microsoft Office Tools
  • Provide daily assistance and backup to the Membership Service Specialist, as needed
  • Other duties assigned as needed.

Data Management Coordinator

Forsythe Technologies
01.2014 - 07.2014
  • The Data Management Coordinator is responsible for data generation and maintenance of data within the Oracle Customer Master and Oracle Item Master ensuring high quality of data under appropriate standards following Policy and Procedure documentation
  • The Data Management Coordinator supports internal teams' operational processes adhering to SLAs
  • The Data Management Coordinator is required to understand the Forsythe business, product data and customer data processes and needs
  • Other duties included:
  • Validate and on-board Item Master data using the understanding of Item Master taxonomy (current as well as strategic) and internal data alignment requirements, issues, and limitations
  • Perform bulk add/delete/update processes to onboard new or correct legacy data
  • Enter and maintain item data used for transactions processing using workflow, upload functionality and manually by screen entry as needed
  • Validate records added through workflow against external reference data sources to verify appropriate Item components
  • Adhere to assigned task due dates; tracks and reports on assigned task status
  • Utilize existing reports using multiple tools
  • Generate client address and contact records supporting operational processes, allowing site instances and contact parties of the same Legal Entity records to be grouped under a single unique Customer ID
  • Understands basic process flow for teams supported
  • Required to update and distribute data files following identified guidelines and structures while working within established spreadsheet formats
  • Worked effectively with teams and Data Management team representatives to properly interpret requirements and deliver error-free records into Customer Master.

Member Services Representative/Trainer

American Society of Anesthesiologists
05.2008 - 01.2014
  • The Member Services Representative/Trainer position includes runs reports to validate data and manages cleanup processes
  • Creates reports and queries for regular usage as they relate to membership, membership dues, and membership renewal
  • Analyzes data, performs calculations, identifies, and resolves key barriers/problems
  • Provides reports and data assistance to ASA staff, member leaders, and committees and components
  • Responsibilities also include assisting with marketing and communications efforts, implementing project plans, and continuously evaluating those plans to ensure ASA objectives and timelines are met
  • Other assignments included:
  • Responsibilities include enrolling Anesthesiologists into the Society
  • Creating and process monthly invoices for new and past due members
  • Processing Membership payments, giving all membership policy/procedure
  • Help establish which educational program (CME) fits member's needs
  • Process Publications orders, including RVG, Crosswalk
  • Created a Component Society Grid for Member Services purpose
  • Assist and help colleagues daily with application processes
  • Provide Membership data to Component Societies
  • Keep updates of all detail of provider information in Excel, Microsoft Office Tools
  • Assisted with board of Directors Meetings
  • Assist at the Annual Meeting
  • Maintain confidential files on all provider applications and other supporting documents including uploading documents in SharePoint Maintains an application's underlying database systems in order to insure maximum application performance and availability
  • Responsible for complete cycle of application change management
  • This includes the installation of application patches and management of the application modification lifecycle
  • Contacts application vendor's support and technical personnel in order to resolve application problems, evaluate and recommend revisions to applications
  • Assists in planning, developing, and implementing application policies and procedures
  • Keeps abreast of changes in computer technology, software enhancements and development applications
  • Other duties and projects as assigned.

Interim Membership Billing Manager

UNICARE Health Plans
01.1998 - 01.2004

Provider Enrollment Specialist

01.2000 - 01.2002

Support Clerk

01.1998 - 01.2000

Education

Bachelor of Science - Management and Leadership

Capella University
06.2013

Skills

  • Software Experience:
  • Microsoft Word, Excel, PowerPoint, Access, Visio, CRM, OPTUM, CMS Medicare and Medicaid expert Crystal Report, Oracle, Salesforcecom, SharePoint, ACGI, Data Entry software, BSAR, ADR, SEQ CSP, Provider Data Maintenance, Morrissey Software, iCIMS, GHX, SYMPLR, PARALLON, INTELLICENTRICS, Kaufman Hall/Axiom, Workday, Citrix, Lawson, ImageNow, Infor, Landmark, PECOS
  • Management Skills
  • Business Planning
  • Analyzing Data
  • Customer Retention Strategies
  • Microsoft Office
  • Customer Service Process Improvement
  • Business Needs Analysis
  • Organizational Leadership
  • Content Management
  • Strategic Partnership
  • Strategic Business Initiatives
  • Promotions and Marketing Strategies
  • KPI Monitoring
  • Strategic Networking
  • Strategic Thinking
  • Strategy Development
  • Opinion Polls
  • Continuous Improvement Process
  • Personnel Development
  • Project Management
  • Strategic Leadership
  • Team Member Development
  • Business Intelligence Data Modeling
  • Database Skills
  • Customer Satisfaction
  • Client Consulting
  • Product Line Development
  • Compliance Management
  • Product Launch Management
  • Project Requirements
  • Communications Strategies

Timeline

Strategic Consultant Lead

The Dearborn Group; HCSC
01.2022 - Current

Business Application Analyst

Lurie Children's Hospital
01.2019 - 06.2021

Vendor Credentialing Specialist

Arjo, INC
07.2017 - 01.2019

Contracting Coordinator

DaVita
12.2015 - 02.2017

Provider

Land of Lincoln Health Insurance
12.2014 - 05.2015

Information Database Assistant

Illinois State Medical Society
07.2014 - 12.2014

Data Management Coordinator

Forsythe Technologies
01.2014 - 07.2014

Member Services Representative/Trainer

American Society of Anesthesiologists
05.2008 - 01.2014

Provider Enrollment Specialist

01.2000 - 01.2002

Interim Membership Billing Manager

UNICARE Health Plans
01.1998 - 01.2004

Support Clerk

01.1998 - 01.2000

Bachelor of Science - Management and Leadership

Capella University

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Brenda L. Parker