Chelsea Anderson
Humble,TX
Summary
Experienced Configuration Analyst with 13 years of expertise in provider data management and system configurations within healthcare settings. Skilled in loading contracts, performing root cause analysis, and ensuring accurate provider data across multiple platforms such as Diamond, Facets, ServiceNow Discovery, and QNXT. Seeking a Configuration role to leverage skills in claims testing, UAT, and data migration for operational excellence achievement.
Overview
14
14
years of professional experience
Work History
Provider Claims Auditor
Insight Global-Sentara
12.2023 - 07.2024
- Conducted thorough verification and updates of provider data to ensure accuracy for health plan participation, enhancing data integrity for internal systems
- Analyzed internal payment setups and audited provider and facility records, identifying and rectifying discrepancies through root cause analysis
- Facilitated the migration of provider data from Credstream to QNXT, contributing to data management efficiency and system transition accuracy
- Build and configured benefit plans in QNXT
- Researched claims issues to determine benefit configuration gaps and update configuration as needed
Provider Data Management II/Configuration Analyst
Centene
Houston, TX
04.2023 - 12.2023
- Managed the meticulous entry and verification of provider information into the database, ensuring accuracy and adherence to established documentation protocols
- Conducted comprehensive analysis of provider data to identify and rectify discrepancies and updated demographic details as per modification requests
- Collaborated with Quality Engineering teams to design and execute User Acceptance Testing (UAT), contributing to the refinement of healthcare billing codes and fee schedules
- Implemented, and maintained automated processes within the ServiceNow-Discovery platform to discover and populate the Configuration Management Database (CMDB) with accurate information
Provider Data Management I/Configuration Analyst
Centene
Houston, TX
02.2020 - 04.2023
- Managed the integration of professional contracts into the database, ensuring accuracy through meticulous research and data analysis
- Maintained comprehensive records to support data load processes, adhering to established documentation standards
- Identified and addressed claims affected by system configuration updates, verifying the effectiveness of solutions through systematic testing in QNXT
- Monitored unresolved claims diligently, facilitating timely resolutions and maintaining system integrity
Provider Operations Coordinator
WellCare
Houston, TX
09.2018 - 02.2020
- Conducted comprehensive root cause analyses for operational and health services issues to enhance organizational efficiency
- Managed the review and processing of critical documentation, including provider credentialing, contract maintenance, and directory updates
- Assisted in the verification of provider credentials and supported annual HEDIS data collection efforts as directed by project management
Customer Service Medicaid Claims
Aetna-Contractor
Houston, TX
07.2017 - 06.2018
- Resolved complex billing issues by applying an in-depth understanding of the revenue cycle, including hospital and physician billing practices and the interpretation of insurance benefits explanations
- Conducted meticulous research and verification of state Medicaid program changes to ensure accurate provider enrollment and compliance with regulations
- Analyzed and rectified medical claims using industry-standard platforms (e.g., NaviNet, Availity, Facets), ensuring the correct application of adjustments and insurance payments, and managed follow-up on medical record requests within HEDIS database tools
Telephone Information Specialist
Harris County Appraisal District
Houston, TX
03.2015 - 05.2017
- Accurately processed and updated property owners' exemption applications, wills, and deeds, ensuring account data integrity by correcting, deleting, or reentering information to resolve discrepancies and prevent data duplication
- Developed proficiency in multiple proprietary software systems, enhancing the efficiency of data management and operational workflows
- Analyzed and identified problematic accounts, effectively gathering critical information from property owners and coordinating with appropriate departments to facilitate timely resolutions
Enrollment Specialist
Cigna Health Spring-Contractor
Houston, TX
06.2014 - 03.2015
- Resolved customer inquiries, including those from policyholders and providers, ensuring accurate information dissemination on claims, benefits, and eligibility
- Conducted thorough research and provided informed responses to beneficiary inquiries regarding the Patient Protection and Affordable Care Act, while verifying Medicare Part A and B eligibility using Facets software
Diagnostic Scheduler
Veterans Evaluation Services-Contracted
Houston, TX
05.2013 - 10.2013
- Coordinated appointment scheduling for patients using various platforms, ensuring effective communication with healthcare providers to maintain quality care and satisfaction
- Provided clear pre-testing instructions and assisted veterans in gathering necessary documentation for claim submissions, enhancing their understanding and streamlining the process
Customer Service Representative
Just Energy
Houston, TX
07.2011 - 05.2013
- Addressed customer inquiries and resolved complaints by implementing negotiation and empathy strategies, ensuring a high level of satisfaction and retention
- Coordinated with cross-functional teams to initiate service orders and manage escalated communications, enhancing interdepartmental collaboration and customer issue resolution
Customer Account Executive
Comcast
Houston, TX
03.2010 - 07.2011
- Resolved customer inquiries regarding billing and account deposits, ensuring clarity and customer satisfaction
- Enhanced revenue by upselling cable, telephone, and internet services and efficiently coordinated service calls to address technical issues
Education
AAS - Healthcare Management
Fortis Institute
Houston, TX12.2023
Skills
- SQL
- Facets
- Provider Data Management
- Claims Testing
- Claims Processing
- QNXT
Timeline
Provider Claims Auditor
Insight Global-Sentara
12.2023 - 07.2024
Provider Data Management II/Configuration Analyst
Centene
04.2023 - 12.2023
Provider Data Management I/Configuration Analyst
Centene
02.2020 - 04.2023
Provider Operations Coordinator
WellCare
09.2018 - 02.2020
Customer Service Medicaid Claims
Aetna-Contractor
07.2017 - 06.2018
Telephone Information Specialist
Harris County Appraisal District
03.2015 - 05.2017
Enrollment Specialist
Cigna Health Spring-Contractor
06.2014 - 03.2015
Diagnostic Scheduler
Veterans Evaluation Services-Contracted
05.2013 - 10.2013
Customer Service Representative
Just Energy
07.2011 - 05.2013
Customer Account Executive
Comcast
03.2010 - 07.2011
AAS - Healthcare Management
Fortis Institute