Clarice L Maxwell
Summary
Diligent Configuration Director with solid background in configuration management and system optimization. Successfully implemented configuration changes that streamlined operational workflows and enhanced system reliability. Demonstrated expertise in problem-solving and process improvement.
Overview
18
18
years of professional experience
Work History
Benefit Configuration Analyst
Health One Alliance (HOA)
01.2024 - Current
- Work directly with the Medical Management Team to ensure high coding standards by adhering to industry best practices and staying current with emerging technologies.
- Improve the configuration processes by streamlining workflows allowing for more auto adjudication.
- Conduct root cause analyses of configuration issues, identifying areas for improvement and implementing corrective actions accordingly.
- Lead the Change Control Board meetings, ensuring comprehensive documentation of all steps and timely resolution of tickets.
- Manage the Optum clinical editing system and configure customized rules as needed.
Director of Configuration
Evolent Health
11.2013 - 08.2023
- Managed a staff of7 individuals, including hiring, career growth and performance management to ensure that both departmental and organizational goals were achieved
- Designed and implemented automated processes to alleviate manual intervention
- Analyzed metrics to predict future efforts
- Collaborated with various cross functional teams (EDI, Enrollment, IT, Claims, etc.) and external teams in designing and analyzing configuration projects to ensure a successful implementation
- Drove ongoing improvements and efficiencies in operational practices, tools & processes
- Performed testing and review of system enhancements and design documents for the accuracy of benefits, pricing, clinical editing and coding prior to promoting the build into the core processing system
- Worked Medicaid, Medicare and Commercial Clients
- Performed configuration based on the providers contract with the Client
Medical Claims Analyst
UTSW Medical Center
01.2011 - 11.2013
- Reviewed explanation of benefits that have been denied or partially paid and appealed with the proper documentation to all insurance companies and government agencies
- Performed billing and collections in the accounts receivable department
- Coordinated communications with payers to ensure accurate billing practices, enhanced reimbursement opportunities and achieved cash collections targets and reduced and maintained accounts receivable over 90 days at or below the targeted level
- Identified inconsistencies and trends by all carriers and reported the findings to management with recommendations for resolution
- Ensured that the proper CPT and ICD-9 codes were billed, and reimbursement is per the contract
Client Service Manager
HealthSmart
01.2007 - 01.2011
- Designed and created an incoming email system which attributed to a significant turnaround decrease in Customer Service calls
- Developed and implemented standardized Policy and Procedures for the Client Services Department
- Executed a plan for employees to have a hybrid work schedule
- Met daily with Customer Service and Account Management to review and resolve escalated instances
Skills
- Strategic and analytical planning
- Verbal and written communication
- Decision-making
- Operations management
- Project coordination
- Visium, Aldera, Meditrac (Conduent) and Optum platforms
- Issues resolution
- People management
- Medicare, Commercial & Medicaid plans
- Contract and vendor management
- Complex system configuration
- Business process improvement
Timeline
Benefit Configuration Analyst
Health One Alliance (HOA)
01.2024 - Current
Director of Configuration
Evolent Health
11.2013 - 08.2023
Medical Claims Analyst
UTSW Medical Center
01.2011 - 11.2013
Client Service Manager
HealthSmart
01.2007 - 01.2011
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