Marylin West

• Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
• Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
• Improved business processes by analyzing current practices and recommending optimization strategies.
• Optimized team coordination to ensure streamlined project workflows.
• Implemented best-practice methodologies that improved overall project delivery timelines while maintaining quality standards.
• Enhanced data accuracy by implementing rigorous data validation techniques, leading to more reliable business insights.
• Increased project visibility by creating comprehensive dashboard for real-time status updates, improving stakeholder communication.
• Strengthened regulatory compliance by updating internal processes in line with new industry standards and legislation.

• Responsible for handling grievances through investigation, preparation, effectuation, and presentation of appropriate materials for review
• Audits of internal and external reports, to validate supplemental benefits, adherence to service level agreements, and compliance with regulatory policies
• Partner with internal and external departments, Medical Group, and staff to achieve resolution for member concerns
• Data cleansing, Project tracking, Mapping, HL7, Data visualization, Power Bi, HIE, and ad-hoc reports
• Manages database for cases
• Responsible for timely case resolution and compliance with federal and state regulations, laws, and accreditation standards
• Participate in managing the organizations Grievance, and external review process
• Compose high quality, compliant, grammatically correct, detailed written communication
• Utilized data management skills to ensure accurate tracking of obligations
• Conduct regular audits of internal and external reports
• Maintain dashboards to provide oversight, monitor performance, budgets, and service agreements
• Collaborated with stakeholders to ensure compliance with regulatory standards
• Promoted continuous improvement through knowledge sharing, and training to various teams
• Collaborated with stakeholders across departments to define requirements for new projects
• Implemented SAP related analyzed business processes
• Review, and track administration with internal stakeholders
• Conduct, plan, and approve audits for all vendors (State and Federal), corporate contracts/management
• Approved all new/amended current vendor contracts, managing meetings, data reporting
• Creates, monitor, and evaluate, all audit reports (annually, quarterly, and monthly)
• Involved in product development and pre-launch phase
• Supervised, and trained staff on new procedures, organization skills, and job aid creation
• Development of corporate policies, procedures, and training materials
• Billing, auditing, and reconciliation (state and federal and business reporting)
• Maintained critical information sensitive using Management Information Data Protection

• Account ledgers, account reconciliations, analyzing budgets, and forecasting data, project management
• Business process modeling and data access modeling, data analysis, spearheaded, and querying Access
• Managed and allocated resources for enterprise requirements in a timely manner
• Monitor monthly accounts, (payables, receivables, and loans)
• UI and UX Wireframes, figma interactive to create prototype and mockups.
• Developed a forecasting model that accurately predicted future demand, resulting in an increase in profits of 13%
• Dashboard development, SAS, SQL, project tracking
• Deployed Excel VLOOKUP, FHIR, Pivotable, Tableau, Word, Outlook PowerPoint, SAP, Python, MS Office Suite, ArcGIS, Health Information Exchange (HIE),and Access
• Functionalities to research data issues and cleaned, reformatted, documented user's satisfaction survey data
• Developed data gathering applications
• Appeals and grievance, respond to issues timely and proficiently
• Verifies patient insurance eligibility and benefits and ensures this information is accurately reflected in system
• Patient's account obtaining authorizations from insurance (Medicare, Medicaid, Commercial, Kaiser Permanente) when required
• Data management to ensure data protection and quality, analyze, researched, and identify defects for enhancements
• Analyzed customer data to determine trends in purchasing behavior
• Drafted functional specifications documents outlining project scope, objectives and deliverables
• Developed financial models and forecasts to support business decisions
• Performed cost-benefit analysis of proposed changes to business processes
• Identified gaps between current state and desired future state operations
• Designed test plans, scenarios, scripts, cases, and results matrices to validate system functionality
• Improved application performance through extensive monitoring and diagnostics using Azure Monitor tools.

Provided ongoing support for troubleshooting complex issues related to the deployment and maintenance of Azure resources.