Kimberly A. Vitale
St. Charles,MO
Summary
Business Analyst with extensive experience in the insurance and health care sectors. Expertise in data analysis, user acceptance testing, and process improvement. Recognized for enhancing claims processing efficiency and fostering collaboration across teams.
Overview
38
38
years of professional experience
Work History
Business Analyst II
Centene
St. Louis, MO
08.2018 - Current
- Supported business initiatives through data analysis, identified implementation barriers, and conducted user acceptance testing for new systems
- Identified and analyzed user requirements and procedures to resolve issues and improve existing processes.
- Identified enhancements for performance management and operational reports related to new business implementation processes
- Lead problem solving and coordination efforts between various business units
- Assist with formulating and updating departmental policies and procedures
Claims Liaison II
Centene
St. Louis, MO
08.2015 - 08.2018
- Analyze trends in claims processing issues and identify work process solutions.
- Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes.
- Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
- Document, track and resolve all plan providers’ claims projects
- Collaborate with the claims department to price pended claims correctly
- Assist in continual auditing of the processes to ensure configuration, state mandates, benefits, etc.
- Collaborated with business units to resolve claims issues, ensuring prompt and accurate adjudication
- Analyzed trends in claims processing issues, contributing to identification and quantification of issues and review of work processes.
- Identified eligibility issues and notified applicable departments for resolution
- Audit check run and send claims to the claims department for corrections.
- Perform claims research for State Complaints, Grievance and appeals and Member/Provider complaints to communicate the results to the plan.
Life Claims Supervisor
Kemper Home Services
St. Louis, MO
07.2013 - 08.2015
- Ensured completion of Life Claim department responsibilities, processing Life claims within defined reporting standards.
- Created and maintained training materials to facilitate onboarding of new hires.
- Review system criteria and update materials for training.
- Developed and updated Guiding Principles to align with departmental best practices.
Senior Claims Auditor
Correctional Medical Services/Corizon
St. Louis, MO
03.2012 - 11.2012
- Audited claims for financial, entry, and system errors, documenting findings to facilitate analysis and process improvement.
- Trained new employees on AMYSYS and QNXT claims processing systems, informing experienced employees of system updates.
- Audited claims for accuracy and compliance with company policies.
- Reviewed medical records to ensure proper billing and documentation standards.
- Collaborated with healthcare providers to resolve discrepancies in claims.
Quality Assurance Analyst
Correctional Medical Services/Corizon
St. Louis, MO
01.2008 - 01.2012
- Performed financial and audits of claims utilizing provider contracts and state health plans to determine cause while providing feedback for improvement.
- Audited percentage of Customer Service Phone calls to provide feedback to management.
- Monitored and improved training program effectiveness.
- Monitored training program effectiveness and implemented improvements based on participant feedback.
- Trained staff in current and changing transactional operations.
- Conducted financial audits of claims using provider contracts and state health plans to identify issues and recommend enhancements.
- Reviewed customer service phone calls and provided actionable feedback to management for quality improvement.
Claims Supervisor
Correctional Medical Services/Corizon
St. Louis, MO
01.2000 - 01.2008
- Supervised, trained, and assisted Claims Examiners to achieve optimal claims production while ensuring high accuracy rates.
- Monitored Employee performance on a daily basis.
- Conducted yearly pay raise evaluations for Claims Examiners to align performance with organizational goals.
- Evaluated current Claims Department structure and documented suggestions on restructuring and cross training opportunities to accommodate changes due to business losses/gains, outsourcing arrangements, staffing changes and increased automation.
- Delegated special projects to direct reports.
- Interviewed and assisted with hiring of new employees.
- Evaluated Claims Department structure and proposed restructuring and cross-training strategies in response to business fluctuations and increased automation.
- Interviewed and assisted with the hiring of new employees.
Claims Coordinator
Correctional Medical Services/Corizon
St. Louis, MO
01.1995 - 01.1999
- Supported Claims Examiners in streamlining claims processes, enhancing overall workflow.
- Requested and analyzed production report results to identify trends and inform decision-making.
- Requested refunds
- Initiated refund requests for clients due to billing discrepancies.
- Requested and analyzed results for production reports.
- Assisted Supervisor with special projects.
- Monitored employee performance.
- Observed and recorded employee performance metrics to identify areas for improvement.
Claims Examiner
Correctional Medical Services/Corizon
St. Louis, MO
01.1989 - 01.1995
- Processed medical, dental, prescription, and vision claims to ensure timely reimbursements.
- Verified authorization for payment.
- Managed inquiries from providers and site personnel regarding payment and authorization status, facilitating clear communication and resolution.
- Assisted Supervisor with complex claims and projects.
- Assisted Supervisor in testing claims on Amisys claims payment system.
- Supported Supervisor with complex claims and projects, contributing to efficient claims processing.
Education
Business/Medical
St. Charles County Community College
Business Management
Florissant Valley Community College
Business and Office Procedures and Graphic Arts
North County Technical
Pattonville Sr. High
Skills
- Data analysis
- User acceptance testing
- Data governance
- Requirements gathering
- Process improvement
- Business requirements
- Claims processing
Timeline
Business Analyst II
Centene
08.2018 - Current
Claims Liaison II
Centene
08.2015 - 08.2018
Life Claims Supervisor
Kemper Home Services
07.2013 - 08.2015
Senior Claims Auditor
Correctional Medical Services/Corizon
03.2012 - 11.2012
Quality Assurance Analyst
Correctional Medical Services/Corizon
01.2008 - 01.2012
Claims Supervisor
Correctional Medical Services/Corizon
01.2000 - 01.2008
Claims Coordinator
Correctional Medical Services/Corizon
01.1995 - 01.1999
Claims Examiner
Correctional Medical Services/Corizon
01.1989 - 01.1995
Business/Medical
St. Charles County Community College
Business Management
Florissant Valley Community College
Business and Office Procedures and Graphic Arts
North County Technical
Pattonville Sr. High