Jeri Michelle Irwin
Albuquerque,NM
Summary
Results-driven professional with extensive experience, specializing in data analysis and project management. Proven track record in streamlining processes and enhancing workflow design. Adept at SQL reporting and requirements gathering, delivering impactful solutions that improve operational efficiency and support strategic objectives. Strong communicator committed to excellence.
Overview
40
40
years of professional experience
Work History
Sr. Clinical Program Consultant – Sr Business Analyst II
United Healthcare Group via Contract - Healthcare Support Staffing
Albuquerque, New Mexico
07.2022 - 01.2024
- UnitedHealthcare Group of California had the contract to generate automatic prior approval or denial letters, and referral letters for medical services for the state of California for most of the major insurance companies (Blue Cross Blue Shield, Cigna, Aetna, WellCare, Alignment, Molina, etc.). This included creating letters in over twenty languages.
- Gathered requirements and assisted in the integration of automated letter production for Health Center Partners of Southern California.
- Designed new templates and updated existing ones for all letters. Reused templates, and variable text where appropriate.
- Tested updates and modifications before presenting finalized templates to business owners. Promoted tested letter templates to production.
- Analyzed inventory and identified opportunities to streamline, decommission, and combine. Summarized results, provided recommendations, and presented findings to the manager.
- Gained foundational knowledge of Agile methodology. Developed and managed Smart Sheets and extensive Excel spreadsheets for status tracking.
Financial Services - Business Analyst II
Regence Blue Cross Blue Shield of Oregon via Contract
06.2021 - 05.2022
- Supervised operational tasks supporting Regence consumer-directed health plan under HealthEquity management.
- Carried out multiple responsibilities to ensure uninterrupted program performance.
- Addressed enrollment, claims, and reporting needs identified through email in Financial Services mailbox.
- Evaluated member details in Facets to confirm plan enrollment and group plan data.
- Managed day-to-day variations in issue volume, peaking around major enrollment cycles.
- Validated banking arrangements like HSA, HRA, and FSA via Salesforce.
- Generated comprehensive reports leveraging SQL, Excel, Access Databases, and Tableau.
- Acted as intermediary between Regence and Health Equity, addressing concerns and managing communication.
Business Systems Analyst & Clinical Quality Analyst
United Healthcare Group (HEDIS) via Various Contracts - Healthcare Support Staffing
12.2017 - 03.2020
- Supported HEDIS Roadmap section 5 research and documentation.
- Effectively managed assigned supplemental data sources (SDS), including audit documentation, HEDIS technical specification review, and tracking of supplemental data sources.
- Performed business analysis to identify needs, requirements, and potential solutions.
- Implemented analytical procedures using SQL, Excel, and Access Databases to guarantee prompt report delivery for strategic support.
- Defined and documented medium to high complex business workflows.
- Collected medical records through paper forms and direct electronic pulls.
- Reviewed and scanned medical records, abstracted information, and entered certain review data into the tracking system.
Medical Record Field Reviewer
Change Healthcare (PIA Integrity Audit) via Various Contracts
06.2017 - 10.2018
- Completed training, testing, and quality assessments with high proficiency to know what to look for in medical records.
- Retrieved medical records from paper documentation, database systems, and electronic records.
- Reviewed and scanned medical records, abstracted information, and entered certain review data into the tracking system.
HEDIS Specialist
Molina Healthcare (HEDIS) via Contract – Healthcare Support Staffing
02.2016 - 05.2016
- Accessed records using paper methods, database systems, and electronic records.
- Reviewed and scanned medical records, abstracted information, and entered certain review data into the tracking system.
Clinical Quality Systems Analyst
Ernest Health Inc.
Albuquerque, NM
05.2014 - 05.2015
- Supported the requirements gathering, installation, and implementation of electronic healthcare record applications in community-based acute rehabilitation and long-term acute care hospitals across the United States owned by Ernest Health.
- Formulated test strategies, test plans, test scripts, and test data, as required.
- Designed and developed reports using SQL, Excel, Access Databases and analyzed data to measure clinical outcomes, network performance, and methodology levers.
Business Analyst – Consultant for the New Mexico Health Insurance Exchange (NMHIX)
CGI Technologies and Solutions Inc
06.2013 - 11.2013
- Provided support in the installation, implementation, and ongoing utilization of electronic healthcare records applications and the Health Insurance Exchange (MAHICAN).
- Formulated test strategies, test plans, test scripts, and test data, as required.
Project Coordinator (NM Medicaid Centennial Care Project)
Blue Cross and Blue Shield of New Mexico
03.2013 - 05.2013
- Established effective coordination and communication between all personnel/departments and made sure each is informed about the ongoing activities of the project and the status.
- Updated the project plan for the Project Lead and put together reports of where each area of the project status stood; daily and weekly.
- Scheduled meetings via Webex and documented and stored minutes.
- Followed up with people responsible for duties resulting from the meetings.
Electronic Medical Record (EMR) Systems Coordinator (eClinicalWorks)
First Nations Community Healthsource
Albuquerque, NM
05.2012 - 01.2013
Health Information Technology (HIT) Implementation Specialist
New Mexico Primary Care Association (NMPCA)
Albuquerque, NM
09.2010 - 05.2012
Technical Support Specialist - Radiation Protection Program (RP)
Sandia National Laboratory via Federal Government Contract
04.2009 - 09.2010
Business Systems Analyst, Quality Improvement Dept., HEDIS, GPRA, Stars reporting
Indian Health Service Office of IT via Federal Government Contract
03.2008 - 12.2008
Quality Improvement Analyst, Quality Management Dept., HEDIS/Stars reporting
Lovelace Health Plan
Albuquerque, NM
10.2007 - 02.2008
Various Positions
Blue Cross and Blue Shield of New Mexico
02.1984 - 10.2007
- Held titles of Technical Support II, Quality Analyst - HEDIS/Stars Coordinator, Business Analyst, Data Analyst, User Acceptance Tester, Claims, COB, Adjustments and Pending Claims, and Customer Service.
Education
Database Concepts and Fundamentals, Access, SQL, ORACLE
Central New Mexico Community College
Albuquerque, NMAccounting I, II, III, English 101, Speech 101
National American University
Albuquerque, NMSkills
- Data analysis
- Project management
- Business analysis
- Quality assurance
- Process improvement
- Workflow design
- Requirements gathering
Timeline
Sr. Clinical Program Consultant – Sr Business Analyst II
United Healthcare Group via Contract - Healthcare Support Staffing
07.2022 - 01.2024
Financial Services - Business Analyst II
Regence Blue Cross Blue Shield of Oregon via Contract
06.2021 - 05.2022
Business Systems Analyst & Clinical Quality Analyst
United Healthcare Group (HEDIS) via Various Contracts - Healthcare Support Staffing
12.2017 - 03.2020
Medical Record Field Reviewer
Change Healthcare (PIA Integrity Audit) via Various Contracts
06.2017 - 10.2018
HEDIS Specialist
Molina Healthcare (HEDIS) via Contract – Healthcare Support Staffing
02.2016 - 05.2016
Clinical Quality Systems Analyst
Ernest Health Inc.
05.2014 - 05.2015
Business Analyst – Consultant for the New Mexico Health Insurance Exchange (NMHIX)
CGI Technologies and Solutions Inc
06.2013 - 11.2013
Project Coordinator (NM Medicaid Centennial Care Project)
Blue Cross and Blue Shield of New Mexico
03.2013 - 05.2013
Electronic Medical Record (EMR) Systems Coordinator (eClinicalWorks)
First Nations Community Healthsource
05.2012 - 01.2013
Health Information Technology (HIT) Implementation Specialist
New Mexico Primary Care Association (NMPCA)
09.2010 - 05.2012
Technical Support Specialist - Radiation Protection Program (RP)
Sandia National Laboratory via Federal Government Contract
04.2009 - 09.2010
Business Systems Analyst, Quality Improvement Dept., HEDIS, GPRA, Stars reporting
Indian Health Service Office of IT via Federal Government Contract
03.2008 - 12.2008
Quality Improvement Analyst, Quality Management Dept., HEDIS/Stars reporting
Lovelace Health Plan
10.2007 - 02.2008
Various Positions
Blue Cross and Blue Shield of New Mexico
02.1984 - 10.2007
Database Concepts and Fundamentals, Access, SQL, ORACLE
Central New Mexico Community College
Accounting I, II, III, English 101, Speech 101
National American University
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