Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Jacquelyn Levine

Business Process Quality Assurance
Perry Hall,MD

Summary

To incorporate highly extensive experience providing business solutions and processes that enhance productivity, improve quality and drive sustained business performance throughout the healthcare system.

Overview

16
16
years of professional experience
1
1
Certification

Work History

Senior Business Analyst

GRSI, CMS
Woodlawn, MD
11.2015 - 01.2016
  • Maintained and coordinated technical teams, business units, and support teams’ workflow
  • Collaborated with internal/external stakeholders and team members
  • Responsible for the business requirements and translating those into functional requirements, capturing and drafting of requirements documentation, artifacts, estimation of level of effort (LOEs), creation of use cases, organization of requirements and maintenance of the requirements repository
  • Translated and simplified requirements, analysis and proposal of solutions, deliverables, prioritization and scheduling of work items (planning)
  • Participated in (led most) requirements sessions with internal/external stakeholders and team members
  • Elicited requirements using interviews, document analysis, requirements workshops, business process descriptions, use cases, scenarios, business analysis, task and workflow analysis
  • Evaluated information gathered from multiple sources, reconciled conflicts and decomposed high-level information into details
  • Created and maintained workflows and approved processes
  • Proactively communicated and collaborated with external and internal customers to analyze information needs and delivered the required artifacts (functional requirements (FRD), business requirements document (BRD)
  • Develop requirements specifications according to standard templates.

Business Process Analyst

Northrop Grumman, CMS
Woodlawn, MD
04.2011 - 12.2014
  • Coordinated, collaborated and monitored sub-contractor’s content and offsite Customer Service Representatives (CSRs) content fluency
  • Lead auditor and lead Electronic Healthcare Record (EHR) SME for quality assurance and quality control
  • Made recommendations and resolutions to upper management that may or may not result to termination
  • Collaborated the business process flow content on the HBOSC project for the Electronic Healthcare Record (EHR); coordinate all data analysis efforts including, ascertain customer requirements, coordinated with business partners, integrated metrics from multiple sources, and summarizing analyses into reports for the customer and project management
  • Served as a liaison between the customers, CMS
  • RO and development teams
  • Conducted CSRs and client audit reviews
  • Participated in project process reviews, reviewed document deliverables, and quality control activities
  • Possess leadership and team building skills, strong interpersonal skills, solid organizational skills and a motivated, flexible team player
  • Performed duties associated with the development and management of scripts used by the EHR Incentive Program CSRs
  • Developed and sustain a reliable tracking system
  • Facilitated and led meetings internal/external to ensure company interests are protected while serving the needs of our customers
  • Performed duties such as tracking and trending with the auditing for the EHR Program
  • Ensured the highest levels of customer satisfaction achieved
  • Participated in HBOSC/CMS calibration sessions
  • Adhered to corporate policies, initiatives, and directives.

Healthcare Business Analyst

Northrop Grumman
Woodlawn, MD
06.2006 - 04.2011
  • Provided business and, and solutions to CMS and their business partners for the Medicare
  • Modernization Act
  • Developed solutions to resolve Medicare Parts A,B,C,and D with an infuses on Part D, as well as, the and Medicare Advantage Plan and Medicaid and Low Income Subsidy program issues
  • Planned and conducted research in the problem areas, in conjunction with analyzing resolutions and making recommendations to management to resolve all problem areas
  • Monitored and tracked trends with data management to identify at-risk populations and opportunities for health progression
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  • Conducted in and out of state audits for Health Care Plans, monitored thousands of accounts within the healthcare Plan for all overpayments, reimbursements and membership
  • Prepared and implemented surveys, evaluated various reports and made corrections as necessary
  • Evaluated and produced metrics for quality assurance, quality improvement and performance measures
  • Integrated quality data service into all aspects of project, created a scorecard to monitor and evaluate progress
  • Developed and linked data researched documentation practices to improve quality assurance and improvement
  • Incorporated newly procedures, as well as; educate plans, members providers, etc
  • Prepared reports, audits, notes, charts, surveys, and non-complex briefing materials
  • Developed forms, notices, workflow charts, spreadsheets and procedures required to implement systems and non-systems changes
  • Prepared data for risk analysis for
  • Part D, incorporated data, statistics, and reports analysis
  • Analyzed, researched, reviewed and resolved complex issues and sensitive information in an accurate and timely response to all inquiries
  • Responded to FOIA inquiries request that concern documents, statistics and records
  • Provided extensive research for resolutions on payment reconciliation, reimbursements, Plan and beneficiary payments, co pays, premiums, enrollment and disenrollment transactions issues, made corrections as necessary with heavy issues pertaining to Part C and D
  • Assisted in the development and issuance of specifications, gathered business requirements, procedures, and instructional materials
  • Process payment claims transactions, transaction code sets from Medicare, contractors and providers
  • Reconciled and resolved -State transactions, SSA, COB, RRB, ESRD, Medicaid, Premium Withhold System, MARx and
  • MBD-issues
  • Practiced, established documentation standards, optimize reimbursement and meet regulatory requirements
  • Managed complex applications, maintain files and acted as the liaison between organization, client and
  • Regional Office (RO) for the more complicated issues
  • Provided education on Parts A, B.C and D, Medicare policies, procedures and guidelines
  • Analyzed EDI file transfer, Data Files and assisted external business partners with data exchange and file errors
  • Reviewed, updated and approved Standard Operating Procedures (SOP), policies and procedures, reviewed for approval company/client guidelines for new procedures moving forward, policies and FAQs documentation
  • Acted as the primary support person to the validation and navigation of publications on cms.gov website and navigation of reports, crosswalk and Plan information in HPMS.
  • Collaborated with stakeholders to identify business needs and data sources.
  • Created data models to support decision-making processes.
  • Analyzed data to identify root causes of problems and recommend corrective actions.
  • Identified patterns and trends in large data sets and provided actionable insights.
  • Updated and developed scripts and queries to extract and analyze data from multiple sources.
  • Provided technical support for troubleshooting analytics and reporting issues.
  • Developed and implemented data governance policies and procedures.

Senior Lead Supervisor Healthcare Business Analyst/Medicare SME

Computer Science Corporation, CSC, CMS
Woodlawn, MD
02.2003 - 06.2006
  • Managed and coordinated a staff of 1 assistant and over 40 employees on the 1-800 Medicare project
  • Provided beneficiaries with
  • Plan benefits and Medicare and Medicaid inquires
  • Manage workload, identify workload issues and implement resolutions that complied with all contractors’ directives and procedures
  • Led and participate in all client's (CMS)/internal management meetings and conference calls
  • Attend daily/weekly meetings and developed and revised organization Standard Operations Procedures (SOP)
  • Researched and complied with Medicare/Medicaid policies, procedures and guidelines and complied with CMS's contractual procedures
  • Developed a quick solution format to resolve issues
  • Performed extensive planning and research on problem areas, trending results and making recommendations to management to resolve the problem areas
  • Managed relationship management with government contractors
  • Educated providers, pharmacies and healthcare Plans and beneficiaries on Part A, Part B, DMERC,
  • Part C and Part D on eligibility, enrollment/disenrollment and claims, premiums and co-pay issues
  • Primary educator on Low
  • Income Subsidy (LIS) / Dual Deemed issues
  • Detected Medicare Fraud and Abuse
  • Teamed with QA department for Quality
  • Assurance/Control, analyzed problems, gathered data and developed improvement plans with heavy documentation
  • Monitored and tracked trends, performance compliance with contractual timeliness and Quality Service Level Agreements (SLAs)
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  • QA/QC metrics, prepared reports, charts, graphics, complex and non-complex materials for information, records, and reports
  • Implemented business strategy & direction, project policies design and development
  • Responded daily to all Freedom of Information Act (FOIA) request and inquiries that concern documents, statistics, surveys and records; as well as, validate information in the Federal Register and on websites
  • Conducted weekly and monthly surveys with data management
  • Coordinated daily with RO, Third Party Administrators and all Contractors including FI,
  • Local Carrier, RRB, DMERC, State Operations, and SSA.

Claims Senior Analyst

Clinical Associates
Towson, MD
08.1999 - 10.2002
  • Trained and led 3 claims representatives; supported the distribution for millions of dollars in benefits on a monthly basis to more than 85,000 clients
  • Conducted weekly and monthly inside and field audits on physicians employed by the organization, checking for fraud, kickbacks and monetary mismanagement of company funds and expenses
  • Managed complex issues, implemented strategic goals for department and expedite deadline goals
  • Researched and reviewed complex Medicaid, Medicare, Third Party (TPA) and Coordination of Benefits (COB) accounts
  • Adjudication, heavy documentation; appealed and negotiated the release of over $100,000 in lump sum payments of benefits
  • Made corrections in system on claims and payments error
  • Managed an active monthly caseload of 200+ clients and maintained computer technology to modernize processing operations
  • Assisted in the development and issuance of specifications, requirements, procedures, and instructional material to process claims from
  • Medicaid, Medicare, contractors and providers
  • Developed forms, notices, workflow charts, and procedures required to implement department changes
  • Administered AR, billing process, processing of Medicaid and Medicare parts A,B, C, and
  • DMERC provider claims, adjustments and reimbursements
  • Conducted monthly stats, surveys and audits to ensure compliancy within Federal and State guidelines, regulations and processes
  • Tracked trends and errors to discussed continuous progressions with processes
  • Maintained relationship with government and State Operations, CMS contractors, providers, representatives of the health care industry to ensure compatibility with provider administration practices
  • Managed daily productivity requirements and team projects with solutions to resolve department’s issues in the problem areas
  • Educated beneficiaries, healthcare Plans, organization and public on Medicare, Medicare, Third Party and secondary insurance.

Education

Bachelor's Degree - Business Administration Management, Human Resources Management

Strayer University

Certified Business Analyst – - undefined

Villanova University

Master - Business Analyst

Villanova University

Skills

BUSINESS/TECHNICAL SKILLSundefined

Certification

CBAP - Certified Business Analysis Professional

Timeline

Senior Business Analyst

GRSI, CMS
11.2015 - 01.2016

Business Process Analyst

Northrop Grumman, CMS
04.2011 - 12.2014

Healthcare Business Analyst

Northrop Grumman
06.2006 - 04.2011

Senior Lead Supervisor Healthcare Business Analyst/Medicare SME

Computer Science Corporation, CSC, CMS
02.2003 - 06.2006

Claims Senior Analyst

Clinical Associates
08.1999 - 10.2002

Bachelor's Degree - Business Administration Management, Human Resources Management

Strayer University

Certified Business Analyst – - undefined

Villanova University

Master - Business Analyst

Villanova University

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Jacquelyn LevineBusiness Process Quality Assurance