DONNA CLARK
Pittsburgh,PA
Summary
Highly motivated and results-driven professional with a proven track record of reducing costs, improving efficiencies, and helping organizations achieve objectives. Experienced in overseeing company-wide analysis of data pricing and rates to ensure accuracy in provider payment and billing. Skilled at meticulously tracking rates and ensuring accurate pricing configuration. Excel at evaluating data to identify areas for process improvement and development. Expertise as a configuration analyst. Excited to contribute to the role of a focused Clerical Assistant 3. Will compile and analyze pricing reports, create codes for rates, utilization, and capacity against performance goals.
Overview
23
23
years of professional experience
Work History
PRICE CONFIGURATION ANALYST, INTERMEDIATE
UPMC HEALTH PLAN, INC
09.2015 - 04.2024
- Oversees administrative and system processes as they relate to implementing and maintaining the financial pricing claims transactional system for all Health Plan Products
- Analyzing, Identifying, Auditing, and proposing and implementing solutions for all business areas
- Hand-picked and charged with leading departmental training of new assignments and new system implementations
- Subject matter expert supporting internal and external business departments by responding to, troubleshooting, and resolving issues
- Model business requirements for new systems and enhancements for new and existing systems
- 90% reduction in rate and pricing errors by identifying areas of concern that may compromise client satisfaction through data analysis, and proposing solutions based on findings, expertise, and research
- Review monthly reports summary of claims inventory, tracking and negotiation of pricing system errors
- Develop, maintain, and deliver configuration control of documentation including policy statements, business processes, standard operating procedures, meeting agendas, meeting minutes, and document templates.
MEMBERSHIP/BILLING ADMINISTRATOR
HIGHMARK INSURANCE GROUP
01.2001 - 04.2013
- Assisted with system testing to facilitate ease of use and accuracy for users
- Trained employees and managers in enrollment procedures
- Ensured documentation accuracy, processed W-9 Forms, and oversaw Special Projects.
Education
Project and Supply Chain Management -
Pennsylvania State University
State College, PAFashion Retail Merchandising - Business
The Art Institution of Pittsburgh
Pittsburgh, PASkills
- Efficient at prioritizing, detail-oriented, managing time, and working independently through remote work arrangements
- Fostered peer relationships as a small team leader and encouraged employee collaboration, growth, and development
- Understanding of Excel models, data visualization, data presentation, MS Access database query ERD, and entity framework including how these applications can be used to automate processes
- Experience in using logic and reasoning to identify strengths and weaknesses of problems and evaluating options to implement solutions
Workactivities
- Produce reports and summaries of critical and high-cost claims
- Manage daily calls and emails in compliance with regulations regarding business processes and procedures.
- Administer, configure, test, audit, and implement rates and financial pricing on transactional claims systems (OPTUM Testing)
Technologyskills
- Microsoft Office Applications: Word | Excel | Power Point | Access | Teams | Outlook
- Video Conferencing Platforms: MS Teams | Zoom
- Database Applications: Rate Manager | OPTUM |UNIX MC400 |MAC OS | MCNET |OAS |EDI | NNPES | Gemini Dashboard
Professional Highlights
- Entrepreneur performed a strategic analysis of products and of marketing to increase demand for sales
- Managed sells, inventory, and logistics distribution for incoming product
- Oversee the process of retention plans in product sales
- Saved an estimated 1 million dollars in patient, healthcare system, and provider practice fees by preventing a major pricing error
Timeline
PRICE CONFIGURATION ANALYST, INTERMEDIATE
UPMC HEALTH PLAN, INC
09.2015 - 04.2024
MEMBERSHIP/BILLING ADMINISTRATOR
HIGHMARK INSURANCE GROUP
01.2001 - 04.2013
Project and Supply Chain Management -
Pennsylvania State University
Fashion Retail Merchandising - Business
The Art Institution of Pittsburgh