Dawn Bertot
Granbury,TX
Summary
Approaches every position held with a positive attitude and energy. Enjoys being pushed and challenged as well as handling multiple tasks. Have yet to find a task unable to learn quickly and perform accurately. Received many awards and certificates throughout career for excellent team work and going above and beyond. Always ready to learn new things. Enjoys a team environment, but also capable of working under minimal supervision.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Business Analyst IV
IL Meridian Medicaid and Duals program
08.2021 - Current
- Position Purpose: Perform and lead various analysis and interpretation to link business needs and objectives for assigned function and implement process improvements
- Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
- Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes
- Resolve issues and identify opportunities for process redesign and improvement
- Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements
- Evaluate risks and concerns and communicate to management
- Coordinate with various business units and departments in the development and delivery of training programs
- Develop, share, and incorporate organizational best practices into business applications
- Oversee all changes to departmental policies and procedures, including communicating and implementing the changes
- Serve as the subject matter expert on the assigned function product to ensure operational performance
- Pend Coordinator team lead
- Trainer for the Configuration team
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Developed high-quality documentation to support training efforts, helping employees fully understand new systems and procedures.
- Improved business processes by analyzing current practices and recommending optimization strategies.
- Optimized workflow processes to enhance overall productivity and achieve operational excellence.
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
- Collaborated closely with stakeholders to identify opportunities for process improvements and drive continuous innovation in the organization.
- Enabled data-driven decision making with advanced analytics tools, generating valuable insights for the organization.
- Implemented best-practice methodologies that improved overall project delivery timelines while maintaining quality standards.
Business Analyst
Catalyst Solutions (Consultant with Centene)
03.2020 - 07.2021
- Position Purpose: Perform and lead various analysis and interpretation to link business needs and objectives for assigned function and implement process improvements
- Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
- Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes
- Resolve issues and identify opportunities for process redesign and improvement
- Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements
- Evaluate risks and concerns and communicate to management
- Coordinate with various business units and departments in the development and delivery of training programs
- Develop, share, and incorporate organizational best practices into business applications
- Oversee all changes to departmental policies and procedures, including communicating and implementing the changes
- Serve as the subject matter expert on the assigned function product to ensure operational performance
- Ability to travel
- Developed high-quality documentation to support training efforts, helping employees fully understand new systems and procedures.
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
SaaS Delivery Services Manager
Cognizant Technology Solutions
06.2019 - 09.2023
- Principal responsibilities in developing and/or gathering the methodology- and product configuration documentation needed to then perform in this role
- Use assumptions/high level requirements captured during sales process to build out Prerequisites Phase Checklist and “Implementation” Phase Checklist
- Conduct first level Gap analysis between Product and client requirements
- Participate with other teams (e.g
- Product Managers, Product Development, Core Integration) to complete the client assessment and inventory the gap-items which must be developed
- Support the creation of implementation pricing
- Perform system configuration – the actual, hands-on work of configuring the portal
- Conduct full end-to-end test of product(s) to confirm the fully-working, fully-configured System(s) of Engagement, to be delivered to clients at the end of the Prerequisites Phase
- Support other teams during identification of data migration activities
- Support other teams during Identification of systems integration activities
- Support other teams during branding activities
- Coordinate the User Acceptance Testing being conducted by client team
- Assist client in coordinating DevOps deployment and client’s Go-Live schedules
- Remove blockers for Go-Live
- Coordinate with learning services and client team to ensure training delivery readiness and execution
- Communicate to product management any opportunities for greater alignment to client/market requirements and to streamline the implementation activities
- Support multiple client implementation simultaneously
- Create and maintain product-level user story repository which will be used as a basis for all the implementations
- Maintain a log of client inputs on product capabilities
- Developed strong relationships with key clients, ensuring long-term partnerships and repeat business opportunities.
- Introduced process improvements that led to faster resolution times for customer issues without sacrificing quality or attention to detail.
Senior Business Process Analyst
United Healthcare
04.2018 - 05.2019
- Extract data from various tools to complete assigned projects
- Analyze, review, forecast, and trend data
- Support short and long term operational / strategic business activities through analysis
- Develop recommended business solutions research and analysis of data
- Process improvement of efficiency of work
- Liaised with staff managers to collaboratively design process change implementation plans.
- Designed process models to provide clear, understandable tools for presenting complex business processes to individuals with minimal knowledge on topic.
Business Analyst IV
Centene
10.2016 - 04.2018
- Position Purpose: Perform and lead various analysis and interpretation to link business needs and objectives for assigned function and implement process improvements
- Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
- Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes
- Resolve issues and identify opportunities for process redesign and improvement
- Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements
- Evaluate risks and concerns and communicate to management
- Coordinate with various business units and departments in the development and delivery of training programs
- Develop, share, and incorporate organizational best practices into business applications
- Oversee all changes to departmental policies and procedures, including communicating and implementing the changes
- Serve as the subject matter expert on the assigned function product to ensure operational performance
- Ability to travel
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Developed high-quality documentation to support training efforts, helping employees fully understand new systems and procedures.
Business Analyst II
Centene
09.2015 - 10.2016
- Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function
- 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
- Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
- Identify ways to enhance performance management and operational reports related to new business implementation processes
- Develop and incorporate organizational best practices into business applications
- Lead problem solving and coordination efforts between various business units
- Assist with formulating and updating departmental policies and procedures
Employer Install Administrator
United Healthcare
07.2011 - 09.2015
- Positions in this function are responsible for the design, development, execution, and management of QA measures that impact critical business functions across multiple markets and systems
- Assesses and interprets intent of institutional and physician contracts to determine system compatibility and configuration accuracy
- Creates and executes standard, repeatable test protocols to ensure configuration accuracy and the timely identification and resolution of defects
- Adheres to testing schedules tied to key project milestones
- Supports production turnover activities, including evening and weekend release activity
- Works with team leads; progresses to increasingly complex tasks and projects
- Translates concepts into practice
- Maintains SOX-compliant documentation, including testing outcomes, defects, risks, change controls, issues, and decisions
- Executes and analyzes reports/data to verify the accuracy of system configuration against contract intent and claim payment trends
- Identifies and solves gaps and bugs to reduce potential for pended claims and payment errors
- Validates auto adjudication accuracy and related payment rule configuration through focused testing and analysis
- Presents testing results and information to internal department customers
- Ensures that system configuration adheres to Medicare, Medicaid, and other federal/state regulations
- With CQM partners, participates in meetings and conferences calls with internal and external customers
- Monitors inventory controls, provides status reports for assigned projects
- Continually improves test script design to ensure that system support tables, interfaces, third party pricing tools, provider contracts, and member benefit packages are configured properly to pay claims and apply benefits for our members/providers
- Interfaces with internal team and department members cohesively, to share knowledge and data to support achievement of department goals
- Handled sensitive information discreetly, maintaining strict confidentiality at all times as required by company policy or legal regulations.
- Maintained personnel records and updated internal databases to support document management.
Senior Claim Associate
Cigna Healthcare
12.2001 - 07.2011
- Audited claims to validate accuracy
- Adjusted claims that were found to be inaccurate
- Tracked and reported trends through claims projects received on excel grids
- Complex high dollar claim processor / CMS-DRG
- Investigated reasons claims were paid inaccurately either by system or human error
- Provided feedback to claim processors if processor error was found
- Trained processors in the30/60/90 day pend process
- Was part of a special team that focused on large scale claims projects
- Reduced claim-processing errors through thorough investigation and effective communication with all parties involved.
Education
Associate of Science - Healthcare Administration
Colorado Technical University
03.2014
Skills
- Microsoft Word / Excel / PowerPoint/ Outlook / SharePoint /O365
- SQL Server / Sybase / Golden
- Microstrategy
- Compliance360
- Facets2 yrs–
- User Acceptance Testing for the Configuration team
- Read the contracts loaded into Facets by configuration
- Create new claims for testing purposes
- Review the configuration criteria for testing purposes to validate that the correct configuration is being tested IE: correct provider type, using the valid codes from the contract, verifying rates are applied correctly as well as benefits
- Navigate through Facets easily
- Amisys Claims Platform -5 yrs
- Configuration in Amisys – Benefits and Pricing
- DST Pricer -5 yrs
- Company based programs
- Answering Phones and other general office tasks
- Power BI
- Application LifeCycle Management
- Ability to read and interpret all types of provider contracts in order to update claim systems properly per benefits and rates
- SDLC
- Contract Implementation
- Provider Data Management
- Data analysis
- Requirements gathering
- Team collaboration
- Microsoft Office Suite
- Microsoft Excel mastery
- Business process improvement
- SQL proficiency
Certification
- SCRUM Master Certification – ID#682383
- SCRUM Fundamentals Certified – ID#682084
OBJECTIVE
Determined to obtain a position that will be challenging as well as rewarding. Experienced in research as well as analyzing data. Motivated and willing to learn what it takes to perform any task given.
QUALIFICATIONS
- Twenty plus years of experience within the health insurance industry
- Twenty plus years of experience within an office environment
- 15 Plus years Business Analyst Experience
- 15 Plus years User Acceptance Testing Experience
- Proficient with all Microsoft office products
- Quick learner with amazing multi-tasking skills
- Well organized and detail oriented
- Time / workload Management
- Ability to work independently / Telecommute Experience
- Excellent under pressure
- Problem Solver
- Team player
- Analysis / Research
- Strong oral and written communication skills
- Knowledgeable in Medicare, Medicaid, Commercial, and Marketplace
- CMS / APG / DRG / RBRVS processing
- Hospital and Medical Claims processing
- Expert Data Entry Skills
- Auditing
- Quality Analysis
- Project Experience
- Read and Write Business Requirements
- Reimbursement Methodologies
- Quality Improvement
- Policy and Document writing
Accomplishments
Received several Every Day Impact Awards from peers for Team Work
Was nominated several times for Meridian IL's Monthly MVP awards.
Here are a few things my colleagues have said:
David: Thank you for always taking time with helping and explaining all the different issues I bring your way. You have helped me out more times than I can count! I am always learning something new when we talk and work together. Definitely look forward to continuing to work with you!
Allison: I cannot count how many times Dawn has patiently trained me on how to perform tasks that improve my understanding of issues and allow me to work independently by empowering me with information and best practice techniques. She regularly creates documents to help the entire Medicaid IL team without being asked. Her work ethic is stellar and I'm lucky to have her as a teammate.
Christine: Dawn is a rock star with one of the strongest work ethics I've encountered. She is brilliant, proactive, team-oriented, funny, friendly and a huge asset to the team and the company at large. She's always my go-to whenever I have a question and responds quicker than anyone despite her considerable workload. Thanks for all you do Dawn!!
Holly: Thanks for all of your amazing help with not only me but also the rest of the team, Dawn! Your expertise and resources have been a great help to fill in the knowledge gaps over the past year.
Timeline
Business Analyst IV
IL Meridian Medicaid and Duals program
08.2021 - Current
Business Analyst
Catalyst Solutions (Consultant with Centene)
03.2020 - 07.2021
SaaS Delivery Services Manager
Cognizant Technology Solutions
06.2019 - 09.2023
Senior Business Process Analyst
United Healthcare
04.2018 - 05.2019
Business Analyst IV
Centene
10.2016 - 04.2018
Business Analyst II
Centene
09.2015 - 10.2016
Employer Install Administrator
United Healthcare
07.2011 - 09.2015
Senior Claim Associate
Cigna Healthcare
12.2001 - 07.2011
- SCRUM Master Certification – ID#682383
- SCRUM Fundamentals Certified – ID#682084
Associate of Science - Healthcare Administration
Colorado Technical University
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