KENA D PARKER
Saint Louis,MO
Summary
A highly motivated individual seeking a position which will allow utilization of vast experiences, knowledge, and skills in a professional work environment. Making use of strong interpersonal skills, demonstrating commitment, integrity, and willingness to succeed while employment at United Health Group.
Overview
12
12
years of professional experience
Work History
Senior Business Claims Analyst
UnitedHealth Group
Maryland Heights, MO
08.2019 - Current
- Lead and/or support Associate Business Analysts engaged in efforts to gather, review and approve requirements, specifications, and recommendations to proposed solutions and system changes, Support Implementation Specialists as requested in gathering and approving requirements and specifications for new business implementations/migrations, Corrective action activities include; incident identification, assessment and establishing remediation plans that ensure closed loop process, Manage business risk Proactively identify and resolve global issues that impact multiple providers /members or lines of business, Propose and lead change initiatives to reduce risk and improve NPS, Demonstrate ability to define logic necessary to automate report production and proactive claim assessments, Lead development of reports/tools to increase efficiencies within public sector team, Lead efforts to simplify and reduce redundancy in creation of templates and job aids necessary to drive consistency in claim processing and claim data reporting, Mentor Associate Business Analysts to improve problem solving and root cause assessment skills amongst team
- Directed claims negotiations within allowable limit of $250k and supported successful litigations for advanced issues
Resolution Specialist l - Provider Service Quality
UnitedHealth Group
Maryland Heights, MO
10.2015 - 08.2019
- Perform research to identify business requirements (e.g., interviews, observation, focus groups), Obtain and validate business requirements from applicable stakeholders (e.g., using health plan documentation, provider manuals, national regulatory lists, etc.), Analyze business requirements to determine if existing systems/processes are optimized to achieve those goals, and to identify potential problems/issues/ opportunities, Leverage forecasting systems/processes to identify applicable problems/issues/opportunities (e.g., inventory, inflow, overtime), and analyze historical data/trends to drive inventory inflow and resource planning, Identify root causes of identified claims processing problems/issues (e.g., root cause analysis, workflow analysis), Utilize applicable service standards and other key performance metrics to drive identification of potential, Identify applicable stakeholders and obtain appropriate approvals/buy-in for recommended process improvements (e.g., leadership, business partners), Perform testing/piloting of potential changes to business processes, and ensure effectiveness prior to implementation, Provide ongoing communications/updates to applicable stakeholders on progress/ outcomes of process improvement efforts (e.g., tollgates, leadership presentations, emails), Provide training/education on claims business processes to applicable stakeholders (e.g., claims processors, systems staff, case installation staff, process documentation team, training staff), Demonstrate knowledge of applicable claims processes (e.g., end-to-end claims cycle, auto-adjudication, manual work processes, payment methodologies, rework/adjustment processes)
- Handled escalated calls calmly and professionally, ensuring that even highly dissatisfied customers felt heard and supported
- Analyzed root causes of recurring issues to implement preventive measures, reducing number of future complaints
- Exceeded performance targets consistently by prioritizing workload effectively and managing time efficiently during periods of high call volume or complex caseloads
- Implemented effective communication skills to deescalate high-tension situations, fostering positive relationships between customers and company
PCRS/Provider Claims Resolution Specialist
UnitedHealth Group
Maryland Heights, MO
09.2012 - 10.2015
- Responsible for processing, researching, identifying and obtaining data/information needed to help process claims or resolve claims issues, ensure that proper benefits are applied to every claim, Apply appropriate processes and procedures to process claims (e.g., experience working with providers of Long Term Care Services & Home & Community-Based Services, Medicaid and Medicaid Waiver programs, claims processing policies and procedures, grievance procedures, state mandates, Medicaid/Medicare guidelines, benefit plan documents/certificates, Apply knowledge of applicable laws, regulations and compliance requirements to ensure that claims are processed properly (e.g., HIPAA, PPACA/Health Care Reform, state-specific regulations/grievance procedures, TAT), Responsible for processing adjustments for UHC Community Plans for various states including Kansas, Texas, Maryland, New York, Arizona, Ohio and New Jersey, Place provider callbacks, Collaborate with business partners to resolve issues impacting providers
- Directed claims negotiations within allowable limit of $250k and supported successful litigations for advanced issues
Education
High School Diploma -
Riverview Gardens High School
St. Louis, MO 08.2003 - 5 2007
Skills
Advanced Microsoft, Word, Outlook, and PowerPoint (editing existing document templates, creating formal communications and usage for note taking, organization, etc) Advanced Microsoft Excel (using filters, spreadsheet editing, and data entry into existing cell, work within tables, Macros, V Lookups, Pivot Tables, utilize formulas), Oracle, ORBIT, Tableau Reporting
Intermediate introduction to data visualization tools, SQL Server and regional database tools, system automation processes and workflow data
Advanced experience in issue resolution, provider data and/or contracting, claim payment/adjustments, customer service, process development
Advanced experience with project methodology (requirements, design, development, test, and implementation) Assessing upstream claim processes for impact and downstream processes to ensure desired outcomes, Leading process improvement, workflow development and interpretation, benchmarking and / or evaluation of business processes
Advanced experience with C&S Operations, CSP and Commercial claims processing, Medicaid, Medicare, CSP Facets, OHBS Facets, State Exchange Platforms, Enterprise Now, SBM
Advanced ability to effectively interact with business partners, audit firms, and all levels of staff
11 years’ experience in complex claim operations
Timeline
Senior Business Claims Analyst
UnitedHealth Group
08.2019 - Current
Resolution Specialist l - Provider Service Quality
UnitedHealth Group
10.2015 - 08.2019
PCRS/Provider Claims Resolution Specialist
UnitedHealth Group
09.2012 - 10.2015
High School Diploma -
Riverview Gardens High School
08.2003 - 5 2007
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