FELIX JOHN
Business Analyst
Indian Trail,NC
Summary
Certified Professional Coder with 9+ years of experience in healthcare. Skilled business professional adept at analyzing complex data to drive strategic initiatives. Recognized for improving operational efficiency and supporting decision-making through detailed analysis. Collaborative team member dedicated to achieving results and adapting to dynamic business needs. Proficient in data modeling and process improvement, committed to enhancing organizational performance.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Business Analyst
Centene Corporation
03.2023 - Current
- Able to assist and audit rosters for variety of Health Plan Providers
- Assisted other departments such as National hospitals with their backlog of cases
- Selected to be part of the quality control team, by auditing spreadsheets and submissions into internal systems
- Provide support to other departments in high priority cases
- Participated in testing for a program called Veda
- Train staff as needed
- Versatile in other business areas or departments and learning their process
- Example Salesforce and Xcelys
- Actively lead and took initiative to lead TX Health Plan meetings every 2 weeks, to ensure the PLFs that have been submitted are accurately completed in a timely matter
- Helped assist auditing PLF’s returns/and in PRR review
- Assisted in showing how to use Veda platform and how to dissect artifacts that are received from the software
- Helped provide Quality work on high priority cases, which led to greater number of individual PLFS submitted
- Assisted in fixing up gaps into our internal system with accurate information
- Minimum experience in SQL platform
- Deliver timely accurate and transparent audit results to our stakeholders, to take actions to meet state and federal regulations/expectations
- Met with Arizona HP to provide an overview of our Access and Availability reimagine approach, and help assist them with any gaps they are facing
- Involved in the FAP to Faneuil process training
- Subject matter expert in Medicare summary reports for assigned states
- Subject matter expert providing failed letters for assigned states
Contract Coordinator
Centene Corporation
03.2021 - 03.2023
- Create contracts and manage contracting process utilizing the Emptoris Contract Management System to ensure that new business contract deadlines are met
- Assist with workload assignment for temporary contract coordination staff
- Maintain spreadsheets and databases
- Interface with credentialing staff to ensure data and systems are coordinated
- Provide support to contract negotiators to ensure successful completion of contracting process
- Coordinate with multiple departments to ensure contracting processes are within required guidelines
- Train temporary staff as needed
- Provide support to other departments to ensure compliance with corporate contracting standards
- Nominated for Team Member for the Month of August & December
- Selected to be part of the Quality Control working group to identify workflow improvements
Intake Coordinator
Centene Corporation-Fidelis Care
10.2017 - 03.2021
- Maintains compliance by recording and updating customer account information in company databases
- Coordinates with care management team to determine members’ status and clinical needs
- Completes timely processing and follow up of member and clinical care referrals
- Provides administrative support and information to internal and external customers
- Monthly average of over 250 cases completed for Westchester
Service Coordinator
Centene Corporation-Fidelis Care
08.2015 - 10.2017
- Verified compliance that members’ aide services, lifeline, and home delivery meals are up to date
- Managed a monthly caseload of 200 members
- Conducted monthly status checks with members to ensure that services are provided and address any issues that may arise
- Provided administrative and non-clinical member support related to the personal care benefit and managed Long Term Care product-lines and departments
Patient Access Coordinator
Nyack Hospital
01.2013 - 08.2015
- Conducted interviews with patients or patient representatives to obtain demographic and insurance information
- Entered patient information into the facility system
- Verified insurance coverage and obtain authorization for treatment
- Strictly followed HIPAA guidelines
Education
Certificate Program - Medical Coding
Roxbury Institute of Medical Management
Jamaica, NY04.2016
Bachelor of Science - Healthcare Administration
Manhattan College
Bronx, NY12.2010
Skills
- Data analysis
- Team collaboration
- Microsoft Office Suite
- Workflow Analysis
- Strategic planning
- Database management
- Reporting and documentation
- Business solutions development
- Data visualization
- Analytical thinking
- Decision-making
- Verbal and written communication
- Strategic thinking
- Clear communication
- Multitasking and organization
- Time management
- Requirements gathering
Accomplishments
- Awarded the STAR Award for employee of the month.
- Process Improvement - Achieved revenue objective by implementing cost-cutting measures.
- Sales and Promotion - Achieved status as one of the top 10 store sales performers in the region. Assisted in planning and executing trunk-shows and in-store promotional events.
- Client Interface - Worked in close collaboration with clients, providing accounting, payroll and taxation advice.
- Consumer Research - Effectively executed new marketing outlines based on market research data collected to reflect consumer interest on both tactical and strategic levels.
- Audit Technology Integration - Uncovered $500,000 budget process errors with development of a multiple source analytical auditing tool.
- Data Organization - Classified, recorded and summarized numerical and financial data to compile and keep financial records.
Certification
CPC-A, 09/01/20, Certified to review clinical documentation and translate medical procedures, diagnosis, supplies, and services into codes that are submitted on a medical claim to payers for reimbursement.
Languages
English
Malayalam
Native or Bilingual
Software
Database management
Spreadsheets
Data analysis
Operating systems
SQL (database querying)
Microsoft Excel(advance functions)
Power BI
Tableau
Microsoft Teams
Timeline
Business Analyst
Centene Corporation
03.2023 - Current
Contract Coordinator
Centene Corporation
03.2021 - 03.2023
Intake Coordinator
Centene Corporation-Fidelis Care
10.2017 - 03.2021
Service Coordinator
Centene Corporation-Fidelis Care
08.2015 - 10.2017
Patient Access Coordinator
Nyack Hospital
01.2013 - 08.2015
Bachelor of Science - Healthcare Administration
Manhattan College
CPC-A, 09/01/20, Certified to review clinical documentation and translate medical procedures, diagnosis, supplies, and services into codes that are submitted on a medical claim to payers for reimbursement.
Certificate Program - Medical Coding
Roxbury Institute of Medical Management
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