Donna Lambe
Vancouver,WA
Summary
I have been working in the Medical Insurance field for over 20 years. Having started as a Claims Analyst and worked my way up to regional system integration and configuration work and then to IT Solution Design has provided me with with rare insight into every aspect of claims as well as familiarity with member, provider, benefits and claims data.
I have been responsible for the Claims System integration with multiple external software products since the initial launch of KPCC within Kaiser and also supported large projects thru to implementation. My solutioning areas are often recognized for their stability and ability to deliver on schedule. I am ready for a new challenge that also utilizes the knowledge I've accumulated over the last 20 years.
Overview
25
25
years of professional experience
Work History
Senior IT Consultant
Kaiser Foumdation Hospitals
Lake Oswego, OR
10.2012 - Current
- Supported the implementation of Tapestry AP claims system across 7 Kaiser regions
- Cultivation and documentation of business requirements for multiple large and ongoing projects
- Claims system Integration with and ongoing management and support of multiple vendor software products including Code Editors and CMS Pricers
- Project documentation including External Software Requirements, System Build Requirements. Design Documents, Data Mapping Documents, Reporting Requirements and Level of Effort forecasting
- Initial testing and troubleshooting of vendor delivered software and claims system enhancements
- Participation in Performance Assessments of vendor software and claims system enhancements
- Ongoing Production maintenance and support for integrated vendor software and claims system, including oversight of all application build changes
- Initially assigned to Application Build team as an Application Coordinator, shortly after re-assigned to Solution Design
Senior Configuration Supervisor
Kaiser Permanente
Portland, OR
01.2006 - 10.2012
- Oversaw configuration analysts responsible for all configuration areas of the Diamond Claims Processing platform for Kaiser NorthWest region
- Supplied business requirements for system enhancements and interfaces
- Collaborated with IT Partners and Perot/Dell (claims system software vendor) on system enhancements and upgrades
- Quality Audits on all claims system configuration areas
- Ongoing configuration maintenance and support for all claims system configuration areas
- Oversight of acceptance testing for all system upgrades and enhancements
- Collaboration with other Kaiser Regions' configuration teams on best practices and knowledge sharing
- Configuration and UAT testing support for implementation of Diamond Claims Processing system
Medical Claims Analyst
Kaiser Permenente
Portland, OR
03.2003 - 12.2005
- Manual Processing of all types of Medical claims, including manual application of pricing, benefits and industry standard coding guidelines
- Exceeded all Claims Analyst productivity and accuracy standards
- UAT testing and configuration input into planned implementation of Diamond Claims processing system
Medical Claims Analyst
Insurance Overload
Portland, OR
01.2001 - 02.2003
- Managed large volume of medical claims on daily basis.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Assigned to Kaiser Northwest Claims Operations until hired by Kaiser directly
Medical Claims Analyst
HealthNet/Previously First Choice
Neptune, NJ
01.1996 - 10.1999
- Managed large volume of medical claims on daily basis.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Processed adjustment of complicated claims such as IV Therapy and DME
- Responded to claims inquiries from internal and external sources
- User Acceptance testing of claims system implementation including reporting and troubleshooting of post go live issues
Education
No Degree - Liberal Arts And General Studies
St Peters College
Jersey City NJHigh School Diploma -
Elizabeth High School
Elizabeth, NJ06.1988
Skills
- Systems Architecture Analysis
- Requirements analysis and design phases
- Information Technology Infrastructure
- Application development support
- Problem-Solving
- Organization and Time Management
- Analytical and Critical Thinking
- Technical Analysis
Timeline
Senior IT Consultant
Kaiser Foumdation Hospitals
10.2012 - Current
Senior Configuration Supervisor
Kaiser Permanente
01.2006 - 10.2012
Medical Claims Analyst
Kaiser Permenente
03.2003 - 12.2005
Medical Claims Analyst
Insurance Overload
01.2001 - 02.2003
Medical Claims Analyst
HealthNet/Previously First Choice
01.1996 - 10.1999
No Degree - Liberal Arts And General Studies
St Peters College
High School Diploma -
Elizabeth High School