Maria Marsh
Robbins,TN
Summary
Strong leader and analytical person dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Overview
28
28
years of professional experience
Work History
SR. BUSINESS ANALYST / PROJECT MANAGER
BlueCross BlueShield Of Tennessee Inc.
06.2013 - Current
- Coordinate complete life cycle of projects (e.g., develops, assesses, plans, monitors, evaluates and reports on project plans).
- Coordinate with all departments and other divisions related to system development and configuration.
- Coordinate team assignments to effectively support multiple activities and projects.
- Coordinate internal resources for solution/program/experience delivery.
- Coordinate between Enterprise Information Systems (EIT) and end users to ensure timely resolution to production software.
- Coordinate and implement CMS regulatory changes.
- Develop test plans in detailed documents that outlines test strategy.
- Oversees and manages CMS memos related to Medicare Advantage enrollment, through Keylight system.
- Assessment of Medicare Advantage Enrollment & Billing Department's compliance with the CMS standards.
MEDICARE ADVANTAGE MANAGER, QUALITY ASSURANCE
BlueCross BlueShield Of Tennessee Inc.
01.2008 - 06.2013
- Manage staff through monitoring and auditing processes, coordination and implementation of quality initiatives that will allow compliance with all activities performed within Senior Care Division as well as required by governing and accrediting bodies.
- Assist Medicare Advantage management with setting appropriate goals and standards for performance management.
- Manage coordination of training of employees to meet Medicare Advantage policies, procedures, and performance standards as well as CMS, Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) requirements.
- Ensure effective communication of findings and activities takes place inter-departmentally throughout division.
- Develop and maintain policies and procedures.
- Develop and maintain reporting mechanisms to allow tracking and trending of initiatives and monitoring of progress of improvement actions.
- Utilize detailed analytical skills using accurate logic to analyze complex issues, data, and performance measures, including department work plans and project design.
- Develops and appropriately manages annual budget for department.
BUSINESS ENGINEERING CLINICAL SYSTEMS MANAGER
BlueCross BlueShield Of Tennessee Inc.
03.2005 - 12.2007
- Jointly define business requirements, analyze, design, enhance, configure, and implementation all systems as it relates to Care Management (CM) and Clinical CareAdvance enterprise wide.
- Primary resource for Clinical CareAdvance supervisors and/or managers related to development of process and programs.
- Coordinated development, implementation, and maintenance of CM educational materials.
HEALTH CARE SERVICE SYSTEMS & EDUCATION SUPERVISOR
BlueCross BlueShield Of Tennessee Inc.
01.2002 - 02.2005
- Coordinated with other departments/divisions related to Utilization Management (UM) and CM system development.
- Coordination of UM and CM implementation and validation of internal reports.
- Coordination and tracking of UM and CM system and manual letters.
- Designed and implemented comprehensive curriculum for all Government and Commercial UM and CM staff, both clinical and non-clinical.
- Developed and implemented educational web site.
SR. UM /CARE MANAGEMENT (CM) PROJECT COORDINATOR
BlueCross BlueShield Of Tennessee Inc.
03.1996 - 12.2001
- Assisted in implementation and testing to ensure that every aspect of clinical systems and workflows utilized were properly implemented according to business specifications.
- Provided and facilitated technical and business processes to support production environment.
- Worked with management and system reporting departments to enhance abilities to report specific data required by business standards and outcome measures.
- Serve as liaison between UM and CM, EIT, and Facets Configuration.
Education
Bachelor of Arts - Public Relations And Organizational Communication
The University of Tennessee - Chattanooga
Chattanooga, TN08.1995
Associate of Science - Mathematics
Chattanooga State Community College
Chattanooga, TN05.1993
Skills
- Project Management
- Agile Methodology
- Analytical and Critical Thinking
- Medicare Advantage Programs
- Center of Medicare & Medicaid Services (CMS) regulations
Timeline
SR. BUSINESS ANALYST / PROJECT MANAGER
BlueCross BlueShield Of Tennessee Inc.
06.2013 - Current
MEDICARE ADVANTAGE MANAGER, QUALITY ASSURANCE
BlueCross BlueShield Of Tennessee Inc.
01.2008 - 06.2013
BUSINESS ENGINEERING CLINICAL SYSTEMS MANAGER
BlueCross BlueShield Of Tennessee Inc.
03.2005 - 12.2007
HEALTH CARE SERVICE SYSTEMS & EDUCATION SUPERVISOR
BlueCross BlueShield Of Tennessee Inc.
01.2002 - 02.2005
SR. UM /CARE MANAGEMENT (CM) PROJECT COORDINATOR
BlueCross BlueShield Of Tennessee Inc.
03.1996 - 12.2001
Bachelor of Arts - Public Relations And Organizational Communication
The University of Tennessee - Chattanooga
Associate of Science - Mathematics
Chattanooga State Community College