Summary
Overview
Work History
Education
Skills
Additionalinformation
Timeline
Generic

Carrington Moore

Little Rock,AR

Summary

Business analyst with over 10 years of in healthcare field, business process, business requirements, claims analysis, and system testing.

Key achievements: Collaborated with vendor and state to to cut claims 12.5% of that were suspending.

Overview

11
11
years of professional experience

Work History

Information Technology Senior Consultant

NTT Data Services
04.2021 - Current
  • Collect, understand, and transmit the business requirements for the project, and translate these into functional specifications
  • Serve as liaison between the State business owner and technical stakeholders
  • Research and provide recommendations to the Medicaid client on data quality issues, business problems/decisions
  • Interface with State staff and vendors; ensure State staff and vendors share a mutual understanding of requirements and desired outcomes
  • Verify and assess vendor compliance with project level requirements
  • Support business solution software and analyzing business operations within MMIS
  • Provide the link between the customer, development team, and any third-party regarding software functionality, throughout the development lifecycle
  • Document client’s requirements as Software Requirement Specification and for sign-off by the client
  • Interact with the software engineering team to develop the software solution required by the client
  • Manage client calls, requirement gathering, and analyzing Medicaid project requirements
  • Comprehend client needs, determine solutions, and engage in proposals
  • Use JIRA to track system changes (CSR)
  • Analyze claims data to identify trends, gaps, and inconsistencies
  • Lead Medicaid claims area tester; Develop and execute test cases; Assign and oversee testing tasks for projects of varying sizes.

Professional Business Analyst

Gainwell Technologies
04.2017 - 04.2021
  • Develop strategic plans and design business processes, providing suggestions to improve and strengthen the Medicaid business operations
  • Analyze, process, and identify test defects and recommend appropriate solutions for various issues
  • Assisted in the successful and timely delivery of complex and ambiguous projects; supervised software deployments and UAT Testing with the client; meticulously deployed builds
  • Critically analyzed business requirements to create Claims area Test Plan/Scripts; imported and exported Test Cases
  • Mitigated risks and performed bug repairs to facilitate seamless processes and enhance the IT framework
  • Support and manage change order implementations within Medicaid MMIS
  • Develop test scenarios for verifying the integration of client requirements into the system design during business application testing
  • Routinely consulted with developers and product owners to update product features and intended functionality
  • Supported communication efforts to foster a progressive environment - served as a catalyst for positive change
  • Develop visualization, user experience, and configuration elements of solution design.

Supervisor, Enrollment

Centene Corporation
01.2017 - 04.2017
  • Review and oversaw the workflows and processes for entering and maintaining enrollment information in the appropriate systems
  • Develop, implement, and maintain production and quality standards for the enrollment team
  • Monitor relevant enrollment dashboards to demonstrate current activity
  • Coordinate and resolve any reporting or systems issues with Corporate IT
  • Investigate and resolve complex enrollment and data issues and determine downstream impacts
  • Monitor, escalate, and complex enrollment issues due to processes and recommend improvements for automation to reduce errors
  • Generate internal ad-hoc reports and analysis as needed
  • Partner with department leads on operational enhancement opportunities.

Member Relationship Liaison

Centene Corporation
11.2015 - 12.2016
  • Utilize multiple systems to investigate escalated inquiries on Members and follow the member experience from beginning to resolution
  • Perform prompt and accurate end-to-end resolutions of HICS (Health Insurance Casework System) cases submitted by the Health Insurance Marketplace under CMS guidance
  • Manage resolution of activities in CRM, including HICS from CMS according to defined turnaround times
  • Collaborate with internal teams and external partners to resolve complaints and document issue and resolution in CRM
  • Recommend workflows and policy because of Member feedback and escalation data analysis
  • Work cross functionally with internal departments regarding client needs and requests, work procedures, gaps in policy, and other elements of supporting assigned clients and conduct member, provider and health plan telephonic education as needed
  • Place outbound calls to collect premium payments for pre-enrolled members
  • Provide prompt and reliable support to colleagues in troubleshooting and resolving both routine and complex data issues, ensuring timely completion of tasks
  • Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
  • Research and resolve enrollment and billing issues
  • Project Lead

Business Analyst I

Centene Corporation
11.2014 - 11.2015
  • Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
  • Identify and analyze user requirements procedures, and problems to improve existing processes
  • Update records from 834 files in Softheon and relay to all downstream systems
  • Develop instructional templates, work processes, call flows and process flows, and to aid in the development of training materials and facilitation of courses and distribute guidelines to increase productivity
  • Develop and communicate change management information
  • Perform detailed analysis on assigned projects, recommend potential business solutions, and assist with implementation
  • Guide and mentor new employees through policies and procedures
  • Investigate and resolve data issues and questions regarding member eligibility and enrollment records
  • Analyzed error queue data to identify trends and improve enrollment file processing in member management systems
  • Implement efficient methods to reduce file errors and improve data quality
  • Diagnose problems and identify opportunities for process redesign and improvement
  • Partner with stakeholder groups across the organization to ensure business and technology alignment
  • Project Lead and Subject Matter Expert

Enrollment Processor II

Centene Corporation
09.2013 - 11.2014
  • Respond to internal/external inquiries regarding Health Insurance Marketplace enrollment
  • Assist members with navigation in the member public and secure sites
  • Perform PCP auto-assignment/ member outreach process
  • Work in-bound 834 queues to resolve/ redirect errors and exceptions
  • Place outbound calls to collect premium payments for pre-enrolled members
  • Answer inbound calls from pre-members and members to collect premium payments and respond to inquiries
  • Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
  • Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
  • Assist members and/or providers regarding website registration and navigation
  • Subject Matter Expert

Education

BA in Management – Human Resources -

University of Arkansas at Little Rock
Little Rock, AR

AAS in Business and Accounting -

University of Arkansas Pulaski Technical College
North Little Rock, AR

Skills

  • Business Planning
  • Data Analytics
  • Scalability planning
  • Productivity Improvement
  • Teamwork mindset
  • Business Analysis

Additionalinformation

Communications Skills (listening, verbal, written), Annual HIPAA Training, Expert in Microsoft Office Tools, Analytical/Research Skills

Timeline

Information Technology Senior Consultant

NTT Data Services
04.2021 - Current

Professional Business Analyst

Gainwell Technologies
04.2017 - 04.2021

Supervisor, Enrollment

Centene Corporation
01.2017 - 04.2017

Member Relationship Liaison

Centene Corporation
11.2015 - 12.2016

Business Analyst I

Centene Corporation
11.2014 - 11.2015

Enrollment Processor II

Centene Corporation
09.2013 - 11.2014

BA in Management – Human Resources -

University of Arkansas at Little Rock

AAS in Business and Accounting -

University of Arkansas Pulaski Technical College

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Carrington Moore