I am seeking a new career position as a Sr. Recovery / Resolutions Analyst - National Remote.
Utilizing my 35 years of claims experience.
Overview
35
35
years of professional experience
Work History
Reconciliation Manager
Optum
01.2020 - Current
Develop training program and successfully train 10+ individuals on the process for reconciliation of estimated payments and negative balance
Provide coaching to continue increasing team performance
Collaborate with internal departments to correct discrepancies with finance, claims, eligibility, authorizations, and provider setup
Assist external providers in using Excel documents alongside provider accounts receivable to reconcile estimated payments with claims submitted prior to recoupment of overpayments
Collaborate with internal departments to correct discrepancies with claims, eligibility, authorizations, and provider setup
Partner across the company to build strong networks to drive change and improvement while anticipating potential problems and solving problems
Nominated internally for many awards from colleagues and other internal departments (Ex: Bravo for performance, relationships, and leadership; Superhero nomination)
Sr. Quality Analyst Benefit Configuration
Optum
10.2015 - 01.2020
Audit new Benefit Configuration
Provide expertise in all areas of the claims configuration process by reviewing and auditing claims and configuration to ensure that all internal processes have been followed and that we are compliant with contractual and regulatory requirements
Assess Defects
Serve as a Subject Matter resource
Works as key member of a team to analyze and identify error trends and provide recommendations and feedback to reduce errors and improve claims processes and performance
Test claims to ensure system is processing claims correctly
Processed test claim on the BIC platform (Benefit Intent Certification)
Worked with Project Teams with BIC upgrades (UAT Testing)
Track Audits in Quality Insight
Created ways for process improvements
Trained and mentored other employees
Maintained Quality Insight program for the team
Worked with Project Teams to Upgrade Quality Insight (UAT Testing)
Communicate with the Health Plan
Create New Policy and Procedures
Maintain the Corporate SharePoint
Attend Daily Meetings
Worked with Sarbanes External Audit
User Acceptance testing for Quality Insight Platform
Work with the Health Plan to resolve defects
Plan View – Allocate time
Sr. Configuration Analyst OHBS
Optum
09.2010 - 10.2015
Manage HealthPlan service desk tickets for users who have issues on the Facets claims system
System functionality
Claims payments issues
Triaged claims that were not falling into the correct queues and roles and resolved any issues
Built new Workflow Configuration for Behavioral claims, this includes building new: Qualifier Groups, Routing Rules, Queue Configurator, Role Definitions, Routing Reasons
Communicate directly with the HealthPlan on service desk tickets
Business Analyst in project capacities directly related to Facets
Work directly with business users
Work with business requirements and technical specifications
Communicating directly with development teams
Participate in user acceptance testing
Plan-view – Allocating time
Weekly status reports to Manager
Attend weekly Meetings
Work closely with team members daily
Added Configuration for the following Tables: Procedure Codes, Diagnosis Codes, Service Definitions, Service Procedure Conversion, Supplemental Procedure Conversion
FACETS 5.1 Upgrade Project
Created test claims
Validation of the FACETS to Current Production System
Subject Matter Expert (Dental)
Optum
04.2001 - 09.2010
Serve as a resource to the dental Team(s) in an efficient and effective manner to ensure accurate and consistent claim processing/adjudication
Maintain all Dental Practitioner issues
HOVServices – Non-Keyable Document Management System
OptumHealth Service Requests; Claim set up issues
Maintain all Pending issues
Field Questions and serve as a secondary resource
Responsible for complex claim issues
Work independently and make decisions
Write and implement Policy and Procedures
Have effective communication skills both written and verbal
Keep accurate and timely records
Facilitate meetings with specific teams
Provide feedback for any trending issues
Maintain positive customer relations with internal and external customers
Serve as a resource for the San Antonio Texas call center, Nevada Claims, Gurgaon India & both claims processing Vendors
Work with Trizetto and the IT teams for any FACET or Siebel system issues
Customer Service calls to provider for missing information
Field Service Representative
Optum
07.1995 - 04.2001
Kept accurate and timely review, research and resolution of Physician and Hospital Adjustments
Communicated with the provider and member service through each Specific Health Plan
Kept accurate, daily, weekly and monthly reports
Maintained a 3-4 day turn around time on adjustments
Voided check process
Refund checks
Tracked system problems or claims submission trends
Assisted in cost effective ways to reduce adjustments
Medical Claim Reviewer
Optum
01.1992 - 07.1995
Kept accurate and timely review, research and resolution of Physician and Hospital claims that edited for review
Communicated with both provider’s and members to obtain more information and suggested resolutions so appropriate reimbursement could be made
Kept accurate daily, weekly, and monthly reports
Identified and tracked any system problems or claims submission trends
Assisted in maintaining current and accurate Policy and Procedures
Assisted in cost effective ways for processing Medical Insurance claims
Data Entry Processor
Optum
03.1991 - 01.1995
Accurately processed Physician claims in a timely manner
Kept an accurate logging system for all Health Plan cold storage
Kept accurate daily, weekly, and monthly reports
Pharmacy Claims Processor
Optum
06.1989 - 03.1991
Responsible for accurately processing Pharmacy claims in a timely manner
Track Daily production and submit a weekly report
Boxed, shipped, and tracked all processed claims sent to cold storage
Skills
Process improvement strategies
Conflict resolution techniques
Quality Assurance
Adaptable to market fluctuations
Data Analysis
Prioritizing and Planning
Strategy Development
Decision-Making
Business Relationship Management
Relationship Building
Financial Resource Management
Risk Assessment
Operational Reporting
Critical Thinking
Work Planning
Willing to Learn
Goal Setting
Customer Service
Proactive and Focused
Effective Communication
Team Building Leadership
Community Networking
In-Depth Research
Problem-solving aptitude
Problem-Solving
Capital Raising
Risk Analysis
Adaptability
Excellent Communication
Affiliations
Borderland Humane Society Holding Facility Manager
<ul><li>Profile: Record to Reporting (R2R)</li><li>Performing financial reporting and controlling for across all the entities (in Hyperion and Oracle = JD Edward).</li><li>Performing End to End P&L finalization (Review of accruals, Negative Cash Accrual, prepaid amortization schedule, FX Adjustments, creation, deletion and capitalization of fixed assets, posting of depreciation etc.) & taking calls with Controllers during Months end for further review of P&L.</li><li>Banking process includes positive pay exceptions, stop payment, voiding checks with AP team. Checks movement to unclaimed property. Payment proof, remittance details.</li><li>IFRS lease computation complying with IFRS 16 in CoStar – Real Estate Manager system (this is only for lease).</li><li>Preparation of webforms and variance analysis report and sharing with stakeholders with detailed information.</li><li>Performing Balance sheet reconciliation with adherence of policy and clearance of open items along with relevant details of lines which is overaged however will be staying for long time (i.e.- Bonus and dividends, Common Stocks, Security Deposits).</li><li>Facilitating team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem-solving recommendations, and recommendations of standardizing team operations.</li><li>Cross train resources in order to have backup of each other to help team synergy helping team members to take leaves when required without bothering of work/process deliverables.</li><li>Conduct weekly, biweekly and monthly meetings with stake holders as per their agreement.</li><li>Create opportunities for team members to provide input on procedures/processes and share their expertise with other team members.</li><li>Working knowledge of ERP systems People Soft, ART (Reconciliation software of Oracle), JD Edward, Teradata, Cetova, Hyperion (HFM), Cadency, Blackline, SAP, NetSuite, Workday Adaptive, Coupa, Tableau, CoStar, Alteryx.</li><li>PROCESS IMPROVEMENTS</li><li>Given 12 lean ideas in area of Month End Close journals, Balance Sheet Reconciliations, and Bank Reconciliations.</li><li>Part of a green belt project on quality of reconciliations and BOT implementation (work in progress) – controllership impact</li><li>Bring automation & Marco enabling dash board MIS reporting for monthly SLA, KPI, IC balances, Cash forecasting etc.</li></ul> at Genpact India Pvt. Ltd<ul><li>Profile: Record to Reporting (R2R)</li><li>Performing financial reporting and controlling for across all the entities (in Hyperion and Oracle = JD Edward).</li><li>Performing End to End P&L finalization (Review of accruals, Negative Cash Accrual, prepaid amortization schedule, FX Adjustments, creation, deletion and capitalization of fixed assets, posting of depreciation etc.) & taking calls with Controllers during Months end for further review of P&L.</li><li>Banking process includes positive pay exceptions, stop payment, voiding checks with AP team. Checks movement to unclaimed property. Payment proof, remittance details.</li><li>IFRS lease computation complying with IFRS 16 in CoStar – Real Estate Manager system (this is only for lease).</li><li>Preparation of webforms and variance analysis report and sharing with stakeholders with detailed information.</li><li>Performing Balance sheet reconciliation with adherence of policy and clearance of open items along with relevant details of lines which is overaged however will be staying for long time (i.e.- Bonus and dividends, Common Stocks, Security Deposits).</li><li>Facilitating team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem-solving recommendations, and recommendations of standardizing team operations.</li><li>Cross train resources in order to have backup of each other to help team synergy helping team members to take leaves when required without bothering of work/process deliverables.</li><li>Conduct weekly, biweekly and monthly meetings with stake holders as per their agreement.</li><li>Create opportunities for team members to provide input on procedures/processes and share their expertise with other team members.</li><li>Working knowledge of ERP systems People Soft, ART (Reconciliation software of Oracle), JD Edward, Teradata, Cetova, Hyperion (HFM), Cadency, Blackline, SAP, NetSuite, Workday Adaptive, Coupa, Tableau, CoStar, Alteryx.</li><li>PROCESS IMPROVEMENTS</li><li>Given 12 lean ideas in area of Month End Close journals, Balance Sheet Reconciliations, and Bank Reconciliations.</li><li>Part of a green belt project on quality of reconciliations and BOT implementation (work in progress) – controllership impact</li><li>Bring automation & Marco enabling dash board MIS reporting for monthly SLA, KPI, IC balances, Cash forecasting etc.</li></ul> at Genpact India Pvt. Ltd
<ul><li>Managing Germany, Italy, Spain, Sweden, Qatar, and India payroll.</li><li>Managing Hire to exit process for all countries.</li><li>Processing one-time payments like Retention bonus, sign-on bonus, Relocation expense, sales commission payments etc.</li><li>Updating master files with respect to assigned entities. (New hires, Termination, salary changes, cost center, department class changes).</li><li>Support HR processes related to onboarding, contract changes, terminations, and exit settlements in line with local legislation</li><li>Implemented end to end RSU/Stock option gain/ESPP program from payroll side for all regions.</li><li>Gross to net reconciliation.</li><li>Net payout reconciliation on employee wise.</li><li>Processing stock option (ESOP) taxation through payroll, ensuring accuracy by validating against the Share works report Remitting tax payments monthly within due dates to avoid penalties.</li><li>Processing third party payments (Insurance payments) once payroll is finalized.</li><li>Remitting pension contribution on quarterly basis for Italy.</li><li>Work with payroll service provider/ stake holders to ensure successful delivery of salary payments, compliance, and accounting.</li><li>Review month end /Quarter end closure and make salaries and accruals accounting properly.</li><li>Responsible for all payroll-related payments, forecast cash flow and cash requirement for the payroll.</li><li>Conduct payroll induction for new joiners for India.</li><li>Conduct monthly business review meetings with all service providers.</li><li>Part of product implementation team. (Care-lite tool) employee queries through ticket system.</li><li>Processing full and final settlement for terminated employees.</li><li>Validating investment proofs during year end.</li><li>Working on employee queries daily, responding within SLA.</li><li>Preparing capitalized R&D reports in the month end helps higher leaders to take strategic decisions.</li><li>Posting journal entries on NetSuite.</li><li>Preparing black-line reconciliation reports during the month end (Accrued vacation, accrued commission, Bonus, employee benefits, employee benefits advances).</li><li>Participate in global payroll projects, system testing, and process improvement initiatives.</li><li>Applications Knowledge: Workday, ADP Streamline, Oracle Net suite.</li><li>India Payroll-People work, Global Payroll-ADP Streamline and For Accounting Oracle Net suite.</li></ul> at Sprinklr India Private Limited<ul><li>Managing Germany, Italy, Spain, Sweden, Qatar, and India payroll.</li><li>Managing Hire to exit process for all countries.</li><li>Processing one-time payments like Retention bonus, sign-on bonus, Relocation expense, sales commission payments etc.</li><li>Updating master files with respect to assigned entities. (New hires, Termination, salary changes, cost center, department class changes).</li><li>Support HR processes related to onboarding, contract changes, terminations, and exit settlements in line with local legislation</li><li>Implemented end to end RSU/Stock option gain/ESPP program from payroll side for all regions.</li><li>Gross to net reconciliation.</li><li>Net payout reconciliation on employee wise.</li><li>Processing stock option (ESOP) taxation through payroll, ensuring accuracy by validating against the Share works report Remitting tax payments monthly within due dates to avoid penalties.</li><li>Processing third party payments (Insurance payments) once payroll is finalized.</li><li>Remitting pension contribution on quarterly basis for Italy.</li><li>Work with payroll service provider/ stake holders to ensure successful delivery of salary payments, compliance, and accounting.</li><li>Review month end /Quarter end closure and make salaries and accruals accounting properly.</li><li>Responsible for all payroll-related payments, forecast cash flow and cash requirement for the payroll.</li><li>Conduct payroll induction for new joiners for India.</li><li>Conduct monthly business review meetings with all service providers.</li><li>Part of product implementation team. (Care-lite tool) employee queries through ticket system.</li><li>Processing full and final settlement for terminated employees.</li><li>Validating investment proofs during year end.</li><li>Working on employee queries daily, responding within SLA.</li><li>Preparing capitalized R&D reports in the month end helps higher leaders to take strategic decisions.</li><li>Posting journal entries on NetSuite.</li><li>Preparing black-line reconciliation reports during the month end (Accrued vacation, accrued commission, Bonus, employee benefits, employee benefits advances).</li><li>Participate in global payroll projects, system testing, and process improvement initiatives.</li><li>Applications Knowledge: Workday, ADP Streamline, Oracle Net suite.</li><li>India Payroll-People work, Global Payroll-ADP Streamline and For Accounting Oracle Net suite.</li></ul> at Sprinklr India Private Limited
Avaya Reconciliation Manager at Innovatia India Knowledge Management Center Pvt LtdAvaya Reconciliation Manager at Innovatia India Knowledge Management Center Pvt Ltd