Hi, I’m
Marylin West
Yucca Valley,United States
Summary
Enhanced Compliance Standards: At Conifer Healthcare Solutions, developed and implemented audit protocols with a methodical approach, ensuring 100% adherence to compliance standards. Improved Patient Care Coordination: At Kaiser Permanente, collaborated with clinical teams using strategic focus to enhance patient care coordination, leading to a 10% improvement in patient outcomes. Streamlined Business Processes: At Apria Healthcare, managed cross-functional teams with meticulous attention to detail, resulting in a 15% improvement in operational efficiently.
Overview
31
years of professional experience
4
years of post-secondary education
Work History
Kaiser PermanenteRancho Cucamonga, California
BUSINESS ANALYST
06.2023 - 10.2024
Job overview
- 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.
Conifer Healthcare SolutionsHouston
OPERATIONS ANALYST
04.2022 - 06.2023
Job overview
- 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 System (MIS)
- 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)
- Developed a forecasting model that accurately predicted future demand, resulting in an increase in profits of 13%
Apria Healthcare
REVENUE CYCLE BUSINESS ANALYST
08.2013 - 04.2022
Job overview
- Dashboard development, SAS, SQL, project tracking
- Deployed Excel VLOOKUP, FHIR, PivotTable, 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.
Skills
- Microsoft Access
- Data Management
- Microsoft Excel
- Pivot Tables
- Microsoft PowerPoint
- FHIR
- Data Analysis
- Tableau (Software)
- Adobe Coldfusion
- Medicaid
- Medicare
- Data Protection
- Leadership
- Microsoft Office
- Insurance Management and Aftercare
- ArcGIS (Software)
- Dashboards
- Python (Programming Language)
- SAS (Software), SQL, SAP
- Health Information Exchange (HIE)
- Medical Necessity Doctrine
- Health Insurance Portability and Accountability Act Compliance
- Research Methodologies
- Corrective and Preventive Action
- Auditing Skills
- Accounting Ledgers
- Accounts Payable and Receivable
- Forecasting Skills
- Contract Management
- Data Reporting
- Business Process Modeling
- Budgeting Skills
- Project Management
- Regulatory Compliance
- Power BI
- Data Cleansing
- Data Visualization
- Presentations
- Business Process Improvement
- Attention to Detail
Skills
- Microsoft Access
- Data Management
- Microsoft Excel
- Pivot Tables
- Microsoft PowerPoint
- FHIR
- Data Analysis
- Tableau (Software)
- Adobe Coldfusion
- Medicaid
- Medicare
- Data Protection
- Leadership
- Microsoft Office
- Insurance Management and Aftercare
- ArcGIS (Software)
- Dashboards
- Python (Programming Language)
- SAS (Software), SQL, SAP
- Health Information Exchange (HIE)
- Medical Necessity Doctrine
- Health Insurance Portability and Accountability Act Compliance
- Research Methodologies
- Corrective and Preventive Action
- Auditing Skills
- Accounting Ledgers
- Accounts Payable and Receivable
- Forecasting Skills
- Contract Management
- Data Reporting
- Business Process Modeling
- Budgeting Skills
- Project Management
- Regulatory Compliance
- Power BI
- Data Cleansing
- Data Visualization
- Presentations
- Business Process Improvement
- Attention to Detail
Education
University of KansasLawrence, KS
Bachelor of Science from Business
09.2001 - 05.2005
Certification
- CBAP - Certified Business Analysis Professional
- Certified PMP
Timeline
BUSINESS ANALYST
Kaiser Permanente
06.2023 - 10.2024
OPERATIONS ANALYST
Conifer Healthcare Solutions
04.2022 - 06.2023
REVENUE CYCLE BUSINESS ANALYST
Apria Healthcare
08.2013 - 04.2022
University of Kansas
Bachelor of Science from Business
09.2001 - 05.2005
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