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.
10181 Scripps Gateway Ct, San Diego, CA 92131
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
10260 Meanley Dr, San Diego, CA 92131
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
10260 Meanley Dr, San Diego, CA 92131
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.
Ruffin Road, San Diego
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