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Jennifer Wilshaw
American Fork,UT
Work Preference
Job Search Status
Not actively lookingWork Type
Full TimeLocation Preference
RemoteSummary
Configuration Analyst with expertise in EPIC system programming for health plans. Enhanced service delivery by programming benefits and contracts while ensuring compliance and accuracy. Skilled in generating analytical reports that detail financial impacts for stakeholders.
Overview
27
27
years of professional experience
Work History
HP Systems Analyst II
University of Utah Health Plans
Murray, Utah
01.2017 - Current
- Enhance service delivery for fully insured TPA individual, Utah level-funded, and Medicaid clients through program benefits in Epic.
- Ensure compliance and accuracy of program contracts and fee schedules within Epic for health plans.
- Generate analytical reports on benefit and contract changes, detailing financial impacts for account executives and contracts management.
- Transition system to Medicaid Prism by updating Epic along with policies and procedures.
- Serve as primary point of contact for Medicaid line of business within the team.
- Coordinate with account owners and stakeholders on processes across all lines of business.
- Maintain documentation on policies and procedures to ensure consistency and compliance.
- Review system issue tickets, identify root cause, and implement solutions within two week SLA.
Configuration Analyst / ADP National Accounts
ADP
Salt Lake City, Utah
01.2013 - 01.2016
- Collaborated with internal and external stakeholders to gather plan setup documentation and confirmed system programming accuracy.
- Tested system configurations to validate compliance with documentation for other configuration analysts.
- Programmed health and welfare products including medical, dental, LTD, STD, and carrier files to ensure accurate benefits administration.
Data Integrity Analyst / C3 Coventry Consumer Choice
Coventry Health Care
Salt Lake City, Utah
01.2007 - 01.2013
- Programmed consumer-driven products in Caregain system, including HRA, FSA, and HSA, ensuring accurate functionality for end-users.
- Collaborated with internal teams to obtain plan setup documentation, verifying accurate programming in the system to support operational needs.
- Reviewed peers' analyses to uphold quality standards, contributing to overall team performance and consistency.
Data Integrity Analyst / Benefits Administration
Coventry Health Care
Salt Lake City, Utah
01.2004 - 01.2007
- Programmed self-funded client benefit plans within claims system to ensure compliance and accuracy.
- Loaded and maintained customized benefit plans according to client specifications to enhance service delivery.
- Worked with Claims personnel and the Testing Department to ensure that the coding of benefit plans functioned correctly and in compliance with medical policies.
- Loaded and tested database upgrades, ensuring accurate data transfer, maintained database tables for claims system, and analyzed new rules/legislation for implications on claims/benefit processing.
Claims Adjuster / Overpayments
Coventry Health Care (formerly First Health)
Salt Lake City, Utah
01.2003 - 01.2004
Provider Data Specialist III / Provider Department
Coventry Health Care (formerly First Health)
Salt Lake City, Utah
01.2000 - 01.2003
Education
Bachelors of Art - History
01-2000
Associates of Art -
01-1998
Skills
- EPIC system configuration
- Benefits programming
- Contract analysis
- Compliance management
- Data analysis
- Data reporting
- Technical documentation
- System configuration
- Process improvement
- Quality control
- Problem solving
- Effective communication
Accomplishments
- Audit completed on Medicaid and HOME plans. Documented the differences between the different plans and notated source of information so others could easily find the information and use in tickets sent to Benefits Team.
- Have taken on some of our difficult high profile clients and was able to program into EPIC unusual custom build.
- Helped Coventry's Sales and Marketing team implement a new database used to feed client information to Implementation team and the C3 Consumer Choice team. Several departments then used this information to program their systems.
- Facilitated new process regarding all C3 Consumer Choice clients that terminate. Created a tracking system to identify terminated clients and worked all steps of their termination, including putting clients on hold once their run-out period was completed, sending reports to the client regarding remaining balances and outstanding overpayments, and served as a contact person for any questions the client had in regards to their termination process.
- Facilitated the new process for testing clients. Provided written documentation for our team on the process of testing during Annual Enrollment.
Timeline
HP Systems Analyst II - University of Utah Health Plans
01.2017 - Current
Configuration Analyst / ADP National Accounts - ADP
01.2013 - 01.2016
Data Integrity Analyst / C3 Coventry Consumer Choice - Coventry Health Care
01.2007 - 01.2013
Data Integrity Analyst / Benefits Administration - Coventry Health Care
01.2004 - 01.2007
Claims Adjuster / Overpayments - Coventry Health Care (formerly First Health)
01.2003 - 01.2004
Provider Data Specialist III / Provider Department - Coventry Health Care (formerly First Health)
01.2000 - 01.2003
Brigham Young University - Bachelors of Art, History
Utah Valley State College - Associates of Art,