Marie Wolski
Peoria,AZ
Summary
Seasoned Quality Consultant and Senior Analyst with a proven track record at Aetna, a CVS Health Company, excelling in data integrity and system analysis. Leveraged expertise in SQL Server and exceptional attention to detail to enhance Medicaid/Medicare operations. Demonstrated leadership in mentoring and process improvement, significantly exceeding quality and production standards.
Overview
11
11
years of professional experience
Work History
Quality Consultant
Aetna, a CVS Health Company
Peoria, AZ
07.2024 - Current
- Responsible for quality audits and projects, etc., associated with the Medicaid/Medicare unit's functional focus.
- Subject matter expert on workflows, policies, components of the system, and on daily operations and programs.
- Responsible for supporting targeted quality audit projects.
- Report results and make recommendations (e.g., training needs, quality controls, and procedures). In partnership with business owners, support the design, development, and validation of desktops.
- May develop and design data collection capability (e.g., customer surveys, focus groups, system reports).
- Under direct supervision, develop and deliver training.
- May provide guidance or expertise to quality staff.
Senior Analyst
Aetna a CVS Heath Care Company
Phoenix, AZ
09.2017 - Current
- Encounter Correction Analyst (AHCCCS) State of AZ, Aetna Medicaid Administrators
- Subject matter expert responsible for talent selection, training, mentoring and employee development while responding to complex issues and proficiently completing health-plan and department projects as assigned
- Applies National Federal, State and Managed Care Cost Containment policies in claim adjudication and reimbursement processing
- Identifies, track trends and resolves benefit, contract, coverage, eligibility, technical, data, billing errors and payment discrepancies
- Creates and develops end user written procedures and policy documents
- Exceeds quality and production standards as set forth by department and the State of Arizona (AHCCCS)
- Reinsurance, Transplant Analyst for the state of Arizona
- Alchemy, DOA (department of Arizona), EDI lookup, EDM, Microsoft Access, Microsoft Excel, Microsoft Visual studios, QNXT
- Quick Base
- SQL server
Sr. Analyst, Encounter Validation Analyst
Aetna Medicaid Administrators
10.2015 - 09.2017
- Responsible for the creation and submission of encounter data to State entities in accordance with regulatory and contractual requirements for accuracy and timeliness
- Understands the impact of actions on system primarily used/maintained
- Understand relationship of designated systems
- Analyzes and verifies system results to ensure accuracy, accountability, and financial data integrity
- Possesses working knowledge of functions of other units in department
- Responds to and resolves customer inquiries and complaints (internal as well as external) both verbal and written correspondence within established unit objectives
- Analyzes and resolves system error conditions within established unit time frames
- Participates as a member of a project team
- Analyzes and recommends solutions to non-standard requests and requirements from plan sponsors and areas within and outside the area
- Processes customer new business and other User system produced data to prepare management level reports
- Oversight for reporting on a complex Medicaid plan
- Alchemy, DOA (department of Arizona), EDI lookup, EDM, EMS, Microsoft Access, Microsoft Excel, Microsoft Visual studios, QNXT
- Quick Base
- SQL server
Encounter Correction Analyst/Sr Benefit Analyst
04.2014 - 10.2015
- Subject matter expert responsible for talent selection, training, mentoring and employee development while responding to complex issues and proficiently completing health-plan and department projects as assigned
- Applies National, Federal, State and Managed care Cost Containment policies in claim adjudication and reimbursement processing
- Identifies and tracks, trends, resolves trends, resolve benefit contract, coverage eligibility, technical, data, and billing and payment discrepancies
- Creates and develops end user written procedures and policy documents for department adherence, eliminating and reducing production waste
- Exceeds quality and production standards set forth by the department and the State of Arizona (AHCCCS)
- Alchemy, DOA (department of Arizona), EDI lookup, EDM, EMS, Microsoft Access, Microsoft Excel, Microsoft Visual studios, QNXT
- Quick Base
Education
Quality Management/Certified Six Sigma Yellow Belt -
Phoenix, AZ01.2017
Quality Management/Certified Six Sigma White Belt -
Phoenix, AZ01.2017
Associate of Applied Science - Nursing/Medical Assistant
Apollo College
Phoenix, AZ01.1994
High School Diploma -
General Tolleson Union High School
Tolleson, AZ01.1985
Skills
- Microsoft Office Suite
- QNXT
- PMMIS
- QuickBase
- SQL server
- Excellent Verbal and Written Communication
- Positive Attitude
- Patience
- Attention to detail
- Multitasker
Qualifications Summary
- People-Oriented. Helping Teams Develop Solutions and Add Value to Customers Experience.
- Focused Senior Analyst with 25+ years of claims, Customer service, experience in the Healthcare industry.
- Expertise includes working in a complex and changing environment with a focus on operational efficiency; possess a strong 'systems thinking,' and ability to articulate the end picture.
- Proven competency in planning, organization, recommending improvements and maintaining ongoing monitoring of system and operational performances for company's revenue.
- Proactively identifies system trends, operational errors, communicates these to senior management and implements issue resolution for SOP.
- Impressive interpersonal skills as a relationship builder, helping teams identify goals allowing them to stay motivated and held accountable.
Timeline
Quality Consultant
Aetna, a CVS Health Company
07.2024 - Current
Senior Analyst
Aetna a CVS Heath Care Company
09.2017 - Current
Sr. Analyst, Encounter Validation Analyst
Aetna Medicaid Administrators
10.2015 - 09.2017
Encounter Correction Analyst/Sr Benefit Analyst
04.2014 - 10.2015
Quality Management/Certified Six Sigma Yellow Belt -
Quality Management/Certified Six Sigma White Belt -
Associate of Applied Science - Nursing/Medical Assistant
Apollo College
High School Diploma -
General Tolleson Union High School