Carisa Slade
Ruskin,FL
Summary
Seasoned Business Analyst with a proven track record at Centene, enhancing system efficiencies and spearheading cross-functional projects. Excelled in analytical research and relationship building, achieving significant process improvements. Skilled in project management and critical thinking, consistently delivering solutions that exceed operational goals.
Overview
21
21
years of professional experience
Work History
Business Analyst II-G&A-Nat Contracting Config
Centene
Tampa, Florida
09.2023 - Current
- Analyzed and investigated system issues reported in tickets, collaborating with technical teams to identify root causes and implement effective solutions
- Documented ticket/inquiry resolution steps and outcomes, maintaining detailed records for future reference and to identify recurring issues
- Managed pricing dispute resolution by investigating discrepancies, collaborating with cross-functional teams to implement adjustments, and ensuring accurate billing and pricing across systems
- Conduct in-depth analysis on assigned projects, provide strategic business recommendations, and support the execution of solutions
- Spearhead issue resolution and facilitate cross-functional collaboration between business units.
- Managed projects and served as primary liaison between client and multiple internal groups to clarify goals and meet standards and deadlines.
- Facilitated and led cross-departmental meetings to resolve issues and ensure effective solutions.
Business Analyst I
Centene
Tampa, Florida
01.2022 - 09.2023
- Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
- Coordinate resolution of escalated issues generated from key stakeholders including partnering with AHCA
- Act as primary liaison between providers, health plans and corporate, including investigating and resolving provider issues
- Support system change processes from requirements through implementation and provide input based on analysis of information
- Research and resolved escalated ticket inquiries
- Identify and analyze user requirements, procedures, and problems to improve existing processes
- Diagnose problems and identify opportunities for process redesign and improvement
- Serve as the subject matter expert on the assigned function product to ensure operational performance
- Develop and maintain relationships with various departments to coordinate efforts to provide the provider with a comprehensive response to various claim issues
Outpatient Utilization Management/ Referral Specialist I
Centene
Tampa, Florida
01.2018 - 01.2022
- Processes all prior authorizations to completion utilizing appropriate review criteria
- Acts as a subject matter expert
- Works towards gathering information on various matters related to tasked assignments
- Provides first level clinical review for all outpatient and ancillary services requiring authorization
- Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services
- Lead coordinator and preceptor for prior authorization
- Assists with special projects or special assignments and completed by deadlines
- Provides first level reviews for all outpatient and ancillary prior authorization requests for medical appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and determination
- Research and determine status of medical related claims
- Process pended medical claims, verifying, and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility
RCM Claims Analyst/ Auditor
Care Centrix
Tampa, Florida
01.2012 - 01.2018
- Oversees accounts receivable adjustments to resolve overpayments and payment rejections according to standard operating procedures
- Research and resolved escalated ticket inquiries regarding claim payments
- Analyzes and clears payment variances
- May prepare adjusted and corrected bills or adjust accounts receivable entries in accordance with existing operating procedures
- May include the use of special reporting
- Verifying pricing and prior authorizations to accurately capture the data for processing
- Review, analyze and process claims
- Conduct quality audits of claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
- Analyze errors and determine root causes for appropriate classification
Utilization Management/SMS / Analyst
Care Centrix
Tampa, Florida
01.2012 - 01.2018
- Served as liaison between management, clinical staff, and providers
- Used analytical skills to assist callers with inquiries
- Clearly and completely documents business requirements for review and approval by operational stakeholders, department staff, and all team members
- Create test cases to ensure the proper configuration and implementation of business rule
- Analyze claim data to identify areas for refinement of medical policy and associated rules
- Creates and maintains reports for business operations and special projects
- Processed authorizations request for sleep apnea patients
- Assisted patients and providers with authorization requests
Healthcare Trainer/ Prior Authorization Representative
Coventry Healthcare
Tampa, Florida
01.2009 - 01.2012
- Trained new hires on systems and health plan benefits so they can perform their everyday job duties/task
- Create workflows for everyday job functions
- Works as a subject matter expert (SME) to assist co-workers with their job duties
- Independently identify issues of non-compliance and/or significant deficits during the monitoring/auditing of cases
- Audited prior auth reps on completed assignments to ensure accuracy
Benefit Specialist / Customer Marketing Representative
Citrus Healthcare
Tampa, Florida
01.2006 - 01.2009
- Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff
- Created and maintained computerized record management systems to record and process data and generate reports
- Explain benefits, eligibility status, and member enrollment processing procedures to callers
- Verify the status of authorizations and/or referrals
Customer Care Professional / Claims Specialist
United Healthcare
Tampa, Florida
01.2004 - 01.2006
- Closely collaborated with management team to make necessary improvements and satisfy resident needs
- Took inbound calls from agents/ brokers on eligibility issues
- Provided information on insurance policies regarding small business groups
- Assisted benefits administrators on their billing and enrollment inquiries
Education
Pre-Medical -
Hillsborough Community College
Tampa, Florida01.2005
Diploma -
Thomas Jefferson High School
Tampa, Florida01.2002
Skills
- Analytical Research Skills
- Relationship & Team building
- Critical thinking
- Organizational Skills
- Project Management
- Auditing & Training Expertise
- Staff training & development
- Analytical Problem Solver
- Statistical Proficiency
- User acceptance testing
- Business process improvement
Timeline
Business Analyst II-G&A-Nat Contracting Config
Centene
09.2023 - Current
Business Analyst I
Centene
01.2022 - 09.2023
Outpatient Utilization Management/ Referral Specialist I
Centene
01.2018 - 01.2022
RCM Claims Analyst/ Auditor
Care Centrix
01.2012 - 01.2018
Utilization Management/SMS / Analyst
Care Centrix
01.2012 - 01.2018
Healthcare Trainer/ Prior Authorization Representative
Coventry Healthcare
01.2009 - 01.2012
Benefit Specialist / Customer Marketing Representative
Citrus Healthcare
01.2006 - 01.2009
Customer Care Professional / Claims Specialist
United Healthcare
01.2004 - 01.2006
Pre-Medical -
Hillsborough Community College
Diploma -
Thomas Jefferson High School
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