Summary
Overview
Work History
Education
Skills
Otherpointsofinterest
Accomplishments
Other Information
Timeline
AdministrativeAssistant
MARGARET TERRY

MARGARET TERRY

International Falls,MN

Summary

I am seeking a career position as a Senior Installation Administrator Benefit Content Configuration. Utilizing 4+ years as a Reconciliation Manager. Results-driven, experienced in financial statement review, auditing and reporting. Well-versed in producing reports, evaluating department operations and handling month- and year-end closings. Meticulous, conscientious and methodical in approach. Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.

Overview

23
23
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
  • 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).
  • Developed and maintained strong relationships with internal and external stakeholders to ensure smooth communication during the reconciliation process.
  • Strengthened internal controls through periodic reviews of existing protocols in line with evolving industry standards.
  • Optimized the use of technology tools in managing reconciliations, enhancing productivity and reducing manual workloads.

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
  • Omega
  • 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.
  • Improved product quality by implementing rigorous testing protocols and identifying areas for improvement.
  • Analyzed defect trends to identify recurring issues, proactively addressing underlying causes before they impacted end-users or production timelines.
  • Coordinated with suppliers to ensure adherence to strict outsource partner guidelines, maximizing the quality of components and materials used in product assembly.
  • Created test cases and automation scripts.
  • Communicated between product owners and developers to clarify features.
  • Reduced production errors by training team members on best practices in quality control and continuous improvement techniques.
  • Resolved complex customer issues with thorough investigations, providing resolutions that enhanced overall satisfaction rates and brand reputation.
  • Conducted regular audits of internal processes, identifying opportunities to enhance overall product quality and consistency.
  • Implemented metrics-driven approach to measure process effectiveness, enabling data-driven decision making in pursuit of superior product quality.
  • Enhanced customer satisfaction by conducting root cause analyses and implementing corrective actions for reported issues.
  • Collaborated with cross-functional teams to establish quality standards, ensuring alignment with organizational goals and objectives.
  • Facilitated open lines of communication between departments, fostering a culture of continuous improvement and shared accountability for product performance.
  • Streamlined quality assurance processes through the development of comprehensive test plans and checklists.
  • Created testing protocols to be used across product lines.
  • Drafted technical documents such as deviation reports, testing protocol and trend analyses.
  • Liaised between quality control and other departments and contractors, providing project updates and consultation.
  • Reviewed and validated quality requirements for manufacturing planning, supplier purchase orders, and engineering specifications to meet contract compliance regulations.
  • Interpreted test results by comparing to established specifications and control limits, making recommendations on appropriateness of data for release.
  • Conducted investigations into questionable test results.
  • Documented and executed detailed test plans and test cases and summarized and logged audit findings for reporting purposes.
  • Assessed products or services to evaluate conformance with quality standards.
  • Monitored testing procedures and verified performance of tests according to established item specifications and protocol.
  • Conducted data review and followed standard practices to find solutions.
  • Completed supporting documentation for testing procedures, data capture forms, equipment logbooks and inventory forms.
  • Reviewed production processes and identified potential quality issues.

Sr. Configuration Analyst OHBS

Optum
09.2010 - 10.2015
  • Manage Health Plan 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 Health Plan 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
  • Created test claims
  • Validation of the FACETS to Current Production System
  • FACETS 5.1 Upgrade Project.
  • Supported customers and government teams with accurate, timely information on infrastructure system and service configuration items.
  • Ensured compliance with company standards by conducting thorough configuration audits.
  • Established a culture of continuous improvement within the configuration management team by regularly reviewing processes and implementing new best practices as needed.
  • Reduced errors in software releases by implementing rigorous change control procedures.
  • Conducted root cause analyses of configuration issues, identifying areas for improvement and implementing corrective actions accordingly.
  • Provided timely support for end-users, resolving configuration-related issues quickly and effectively.
  • Safeguarded sensitive information by enforcing strict access controls on system configurations and related documents.
  • Assisted in the implementation of new systems, ensuring seamless integration with existing infrastructure through careful configuration planning.
  • Developed comprehensive documentation for all configuration processes, facilitating knowledge sharing among team members.
  • Enhanced system performance through regular analysis and optimization of configurations.
  • Troubleshot incidents reported by end-users to schedule system changes and identify permanent solutions.
  • Collaborated with upper management to drive strategy and implement new processes.
  • Analyzed existing systems and databases and recommended enhancements to solve business needs
  • Communicated and explained business requirements to team members to understand and implement functional demands.

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.
  • Established best practices for knowledge sharing, fostering a culture of continuous learning and improvement.
  • Developed effective training materials for diverse audiences, resulting in improved skillsets and increased job satisfaction.
  • Streamlined processes to increase efficiency, enabling teams to complete tasks ahead of schedule.
  • Evaluated existing resources and developed new strategies to maximize effectiveness in addressing identified gaps.
  • Managed complex projects from inception through completion, delivering high-quality results within tight deadlines.
  • Supported the implementation of new systems or tools by providing specialized knowledge on functionalities and potential improvements.
  • Served as a liaison between technical experts and business stakeholders to ensure alignment on project objectives and deliverables.
  • Enhanced team performance by providing expert guidance on critical projects and strategic initiatives.
  • Facilitated product development with implementation of standard best practices.
  • Spearheaded internal training initiatives that led to increased employee proficiency in critical skills.
  • Optimized subject matter content by conducting extensive research and incorporating industry trends.
  • Influenced decision-making processes by presenting data-driven insights into key organizational issues.
  • Championed change management efforts during organizational transitions by offering expert guidance on navigating new processes and structures.
  • Documented diagnostic results and supported root cause analysis and troubleshooting.
  • Improved system performance by eliminating operational gaps and software bugs.
  • Educated staff on organizational mission and goals to help employees achieve success.
  • Developed effective improvement plans in alignment with goals and specifications.
  • Devised and implemented processes and procedures to streamline operations.
  • Optimized customer experience by delivering superior services and effectively troubleshooting issues.
  • Cultivated positive relationships with vendors to deliver timely and cost-effective supply of services and materials.
  • Evaluated staff performance and provided coaching to address inefficiencies.
  • Helped meet changing demands by recommending improvements to business systems or procedures.

Education

High School Diploma -

Falls Senior High School
International Falls, MN
06.1982

Skills

  • Strong Communication Skills
  • Team Leadership Qualities
  • Decision-Making Competence
  • Performance Metrics Monitoring
  • Time management mastery
  • Conflict resolution techniques

Otherpointsofinterest

  • Traveled to San Antonio Texas to train the Call Center for Dental Claims adjudication. Wrote the policies for the “One and Done” process for the Call Center
  • Phase I & II of Facets 4.31. Traveled to Rockville Maryland. Worked on building the new FACETS system for Dental
  • Traveled to Rockville Maryland to write the policy and procedures for FACETS dental
  • Traveled to San Antonio Texas for new Siebel Dental Training
  • Traveled to Baltimore Maryland to train the TriZetto team of 20 to help with the dental back log. Audited the TriZetto Team
  • Rolled out the new Facets 4.31 to the International Falls staff.
  • Contact for Facets system issues, worked with the TriZetto to resolve
  • Worked with the Siebel project team testing the system and worked on any system issues that prevented Dental Teams from being able to work.
  • Set up an auditing system so that I could stay current with the auditing results
  • Worked with Web Cast and TriZetto with any new processing issues
  • Audited the Jamaica Team (Dental Data Entry)
  • Audited Ghana India (Dental Data Entry)
  • Attended the Six Sigma training 04/19/06
  • Trained for Dental Customer Service inbound calls for San Antonio Texas
  • Successfully completed all IT Business CRTS on learn well.
  • Access Database
  • PowerPoint (Beginner)

Accomplishments

  • Incedo processing system
  • Incedo desktop – Review payment of claims
  • PaySpan – To review provider checks and transactions
  • OneNote
  • Multiple SharePoints
  • Completed RSA training level 1 & 2 and the workshop through Learn Source
  • UDP – United Development Process
  • Application Landscape
  • ALM
  • Agile Inspection
  • ADR
  • Team Lead (received an award for outstanding accomplishments)
  • Conference Call Leader for Specific Health Plans
  • Cross trained into all functions of all departments (medical, Phy/Hos)
  • Completed the CPT self-study course
  • Completed Medical Terminology
  • Completed the “working’ program
  • Completed “Change Management” course
  • Completed Windows 3.0 course at Rainy River Community College (A Average)
  • Completed all Fraud and Abuse Courses
  • Phone Skills training
  • Access Database (Beginner)
  • Word
  • Excel
  • Total Customer Service
  • CQI training
  • CQI Team Leader
  • Worked on and Illinois “John Doe” project: Building Cosmos claims for the VAX system to recover dollars
  • PC Ors
  • FileNet (Siebel)
  • FACETS (Dental
  • Cosmos background
  • Completed all JRS modules
  • Worked on a JRS project
  • Worked on a Kiazon
  • Completed the “Skill Pathing” program and moved to a grade level 24
  • Systems I have worked in: HOV, VAX, Cosmos, CPQ, TRACR (a little), Multi claims, JAWS, Facets 4.71, 4.31 & 4.1 & Siebel
  • HPSM data base (Helpdesk Tickets)
  • Plainview – Time Allocation

Other Information

Claims Research Team (CRT data base) This involved concrete organization skills. I was the lead for all 40 health plans within the International Falls “Specialized Care” this consisted of all 34 UBH divs and Medical/Hospital. For Field Service, Review and Data Entry., Received projects through this database, Researched the projects to ensure all information was available to complete the project, Worked with each department to ensure the projects were worked within a timely manner, Maintained the projects within the database, Worked with ATG – “Automated Transaction Generator”, Communicated with Health Plan Home teams in daily conference calls, Weekly CRT calls

Timeline

Reconciliation Manager

Optum
01.2020 - Current

Sr. Quality Analyst Benefit Configuration

Optum
10.2015 - 01.2020

Sr. Configuration Analyst OHBS

Optum
09.2010 - 10.2015

Subject Matter Expert (Dental)

Optum
04.2001 - 09.2010

High School Diploma -

Falls Senior High School

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MARGARET TERRY