Kim Miller

• Analyze provider contracts
• Develops and implements complex configurations within the systems
• Completes configurations networks to meet the identified pricing needs
• Configures test claims in networks and reviews configuration results assuring the hightest level of quality
• Documents new requirements and processes for Medi-cal an BSC
• Researches and resolves issues of medium to high complexity that are referred from claims, customers service and provider relations
• Evaluates provider set up in pims and works with provider data maintenance to ensure that the all data is accurate and in synch
• Represents PACC on Medi-cal maintenance implementation, updates and requirements and completes the requirements end to end
• Implements new published medi-cal updates. These updates are completed through updates to fee schedules or mass updates to the agreements using new terms to suffice the new pricing . Using the pega tool for mass updates when needed
• Consults with different teams on new requirements for medi-cal implementation
• Consults with provider contracting to determine best approach in interpretation of the contract and its intent
• Proficient in interpretation and analysis of provider contracts of moderate to high complexity
• One fo the go to analyst for escalated issues for both bsc and PHP
• Leads weekly meetings with stakeholders on Medi-cal
• Makes all task updates within Jira for Medi-cal updates

· Answered questions for members on their benefits

· Responded to complex situations and inquiries from members

· Assisted members in obtaining information so they could get services they required

· Helped members resolve complex care issues

• Built partnerships to help meet fundraising goals
• Created presentations for small and large audiences
• Drove campaign growth though donor cultivation
• Managed customer and campaign information

• Developed relationships with accounts
• Created store demos
• Presented Gallo programs to distributor
• Provided merchandise and service support
• Helped grow a low volume territory into a high volume territory