Leonora Silva
Ramona
Summary
Dynamic Client Services Business Systems Analyst with a proven track record at MedImpact Healthcare Systems. Expert in requirements gathering and cross-functional collaboration, delivering impactful solutions that enhance operational efficiency. Recognized for improving workflows and mentoring teams, driving significant enhancements in client satisfaction and project delivery timelines. Adaptable and results-oriented professional. Thrive in both independent and collaborative work environments.
Overview
25
25
years of professional experience
Work History
Client Services Business Systems Analyst
MedImpact Healthcare Systems Inc.
07.2018 - Current
- Identifies, plans, develops, implements, and maintains business systems solutions that support client operational needs.
- Maintains current understanding of client file layouts, relationships, & logic and how they operate in MedImpact business applications. Provides technical consultations to the client team and related internal stakeholders.
- Translates requirements into business, system & functional requirements and partners with IT Developers in translating requirements into design specifications.
- Managed multiple projects and clients simultaneously, consistently meeting deadlines while maintaining a high standard of quality workmanship.
- Maintains comprehensive documentation of client MedManual, ensuring they are kept current.
Provider Data Services Consultant
Aetna, a CVS Health
04.2015 - 01.2017
- Reviewed fully executed new provider and facility contracts for implementation into proprietary systems; renegotiation analysis to meet client and business needs.
- Conducted various types of analysis related to business and system changes for trends, gaps and impact; highlights in-depth interpretation and provides in-depth root cause analysis.
- Provided business and technical direction relative to provider data structures that are National or Regional Provider contract in scope, in support of auto claim adjudication and member access to directory.
- Collaborated with vendors to review and assess impact of selected contracts to effectively manage potential implications of complex contractual arrangement.
- Mentored junior team members, sharing industry insights and best practices for improved performance.
Supervisor, Customer Service Operations
First Health Managed Care/Coventry Healthcare
05.2004 - 03.2015
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
- Initiated process improvement toward automation of some key processes, reducing rework initiative.
- Collaborated with other departments to achieved organizational goals, fostering teamwork across various functions.
- Developed staff skills through targeted training programs, resulting in improved performance and career growth opportunities.
Business Systems Analyst III
CCN Managed Care, Inc.
07.2000 - 04.2004
- Developed, evaluated and tested pricing logic per provider contract and reconcile claims pricing issues within deadline.
- Analyzed and provided resolution to non-standard requests and requirements from plan sponsors and internal stakeholders.
- Supported Network Data Management and Regional Networks on all National provider maintenance and implementations within business timeline.
- Processed complaints (member and provider), grievance and appeals via internal processes and reporting systems.
- Handled routine phone inquiries and written correspondence related to provider issues.
- Reviewed and analyzed system reports and other information to develop financial reporting.
Education
Bachelor of Science - Accounting
Divine Word University
Tacloban City, PhilippinesNo Degree - Introduction To SQL Programming
UCSD Extension
San Diego, CANo Degree - Microsoft Office Pro
San Diego Community College
San DiegoSkills
- Requirements gathering
- Cross-functional collaboration
- Workflow and Research Analysis
- Root-cause analysis
- Functional specifications
- Data management
- Effective communication
- Adaptabililty and flexibility
Timeline
Client Services Business Systems Analyst
MedImpact Healthcare Systems Inc.
07.2018 - Current
Provider Data Services Consultant
Aetna, a CVS Health
04.2015 - 01.2017
Supervisor, Customer Service Operations
First Health Managed Care/Coventry Healthcare
05.2004 - 03.2015
Business Systems Analyst III
CCN Managed Care, Inc.
07.2000 - 04.2004
Bachelor of Science - Accounting
Divine Word University
No Degree - Introduction To SQL Programming
UCSD Extension
No Degree - Microsoft Office Pro
San Diego Community College
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