Karen Samanamud
Senior Business Analyst
FL
Summary
I am an experienced, results-driven public healthcare professional with over 15 years of experience managing relationships with users and healthcare providers, providing consultations, training, and education services. I excel at relationship-building and managing multiple providers simultaneously. As an organized and well-rounded professional, I'm looking to leverage my talent and experience to take on a dynamic role with a growth-oriented operation in an account management / consultative capacity in the Healthcare field. Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills.
Overview
17
17
years of professional experience
Work History
Senior Business Analyst
Gainwell Technologies
10.2023 - Current
- Create test scenarios used in testing business applications to verify that client requirements are incorporated into the system design
- Writes test plans for all test phases, System, Regression and Performance
- Develop and modify system requirements documentation to meet the client's needs
- Provides input in developing and modifying system requirements documentation to meet the client's needs
- Participates in meetings with clients to gather and document requirements and explore potential solutions
- Participates in technical reviews and inspections to verify that the 'intent of change' is carried through the phase of the project
- Executes systems tests from test plans
- Analyzes test results from all test phases
- Provide input for time estimates on project-related tasks
- Report subsystem issues or project delays proactively to the client and/or management
- Plan and design documents for complex business processes
- Acts as the scribe during complex meetings with clients and thoroughly documents all notes and provides those to appropriate parties along with action items.
Plan and Provider Specialist Team Lead
Gainwell Technologies
08.2021 - 10.2023
- Oversee the Plan and Provider Specialist team
- Approve reports
- Delegate reports and other assignments to the Specialists
- Track all completed and outstanding assignments
- Edit and approve all documents being sent to the client and health plans
- Lead, mentor, and coach Specialists
- Interview prospective new hires
- Plan and design training manuals
- Experience with working on project management teams
- Provide consultant SME (Subject Matter Expert) guidance on multiple projects and to the client
- Create and edit publications and user guides
- Facilitates meetings with the client to gather and document requirements and explore potential solutions
- Acts as the scribe during complex meetings with clients and thoroughly documents all notes and provides those to appropriate parties along with action items.
Provider and Plan Specialist
Gainwell Technologies
12.2015 - 08.2021
- Responsible for educating and assisting all Florida Medicaid providers
- Provide on-site and virtual training visits to all Florida Medicaid providers in and out-of-state providers
- Complete New Provider and High Denial Outreach monthly
- Lead Florida Medicaid provider billing workshops
- Provide technical assistance and formal training to contracted providers in large and small group presentations
- Determine claim denial trends and assist providers in correcting issues preventing claim reimbursement
- Effectively communicate new and updated policy information directly to providers from AHCA (Agency for Health Care Administration)
- Relationship management with contracted Medicaid Managed Care companies to assist with the encounter resolution process
- Assist providers via phone and e-mail with complex billing, enrollment, encounter, and EDI processes
- Attend and lead SMMC plan meetings to assist with questions concerning EDI transmission of encounter files
- Assist with resolution instructions on claims and EDI coding
- Meet with MFAO/AHCA to discuss outstanding SMMC Health Plan Support items
- Work with Fee For Service providers, managed care and capitation plan models.
Case Manager
Northwest Indiana Community Action
04.2007 - 07.2014
- Case Manager- Client assessment and brokerage for in-home services to an aged and disabled population
- Initiated Advanced Case Manager status and competencies
- Produced mechanism for balancing caseloads to demand and shifting needs
- Developed a model for cooperative and progressive collaboration between service staff and management
- Quality Circle and Project Management
- Innovations in the management of a large, diverse, and widespread service
- Implemented pathways for various ethical dilemmas
- Adept at managing multiple projects concurrently
- Served as a mentor
- Contract negotiations.
Education
Bachelor of Arts - Sociology
Purdue University
05.2006
Skills
- Microsoft Office Products
- FMMIS (Florida Medicaid Management Information System)
- Avaya-call center applications
- Provider Enrollment & Credentialing
- Provider Services and Operations
- Florida Medicaid Claims
- Florida Medicaid Financial, Buy-In, TPL, Managed Care (subsystems) Systems
- Extensive Knowledge of Indiana/Florida Medicaid
- Medicaid Managed Care
- Contract Negotiations
- Basic understanding of SQL Developer
- Conflict Resolution & Negotiation
- Leadership & Management
- Account & Client Management
- Detail & Task Oriented
- Critical & Analytical Thinking
- Strong written and verbal communication
- Presentation & Communication
- Consultation & Implementation of multiple projects
- Customer Service Oriented
- Motivate and Inspire others
- Mentor
Timeline
Senior Business Analyst
Gainwell Technologies
10.2023 - Current
Plan and Provider Specialist Team Lead
Gainwell Technologies
08.2021 - 10.2023
Provider and Plan Specialist
Gainwell Technologies
12.2015 - 08.2021
Case Manager
Northwest Indiana Community Action
04.2007 - 07.2014
Bachelor of Arts - Sociology
Purdue University
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