MauKeshia J. Hopkins
Arlington,TX
Summary
Dynamic Business Analyst with a proven track record at Centene Corporate, adept in data management and analytical problem-solving. Leveraged expertise in Microsoft Office and effective communication to enhance operational efficiency and support strategic initiatives. Demonstrated ability to lead cross-functional teams, achieving significant process improvements and fostering customer satisfaction.
Overview
12
12
years of professional experience
Work History
Business Analyst I
Centene Corporate
Clayton, MO
06.2022 - Current
- Perform various analysis and interpretation to link business needs and objectives for assigned function
- Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
- Identify and analyze user requirements, procedures, and problems to improve existing processes
- Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
- Identify ways to enhance performance management and operational reports related to new business implementation processes
- Develop and incorporate organizational best practices into business applications
- Lead problem solving and coordination efforts between various business units
Grievance & Appeals Coordinator I
Centene Corporate
Clayton, MO
06.2021 - 06.2022
- Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members
- Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
- Prepare response letters for member and provider complaints, grievances and appeals
- Maintain files on individual appeals and grievances
- Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
- Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research
Provider Data Management Analyst II
Centene Corporate
Chesterfield, MO
10.2018 - 06.2021
- Maintain accurate databases and reports to monitor network compliance with State requirements
- Review and audit provider set ups within business systems to ensure compliance of all claims and coordinate the data verification process for providers enrolled in networks
- Oversee and coordinate operational and administrative activities associated with provider relations, including provider education and liaison responsibilities, marketing and promotion, and facilitation of credentialing and certification
- Manage and resolve complex provider data issues, such as mass change updates, limited reconciliations and direct submissions of urgent requests
- Coordinate provider data between the health plan database and various external vendors and internal business systems
- Conduct quality audits of provider claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
- Analyze errors and determine root causes for appropriate classification
- Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
Customer Service Specialist/ Provider Claims Analyst Liaison II
Centene Home State Health Plan
Chesterfield, MO
03.2017 - 10.2018
- Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner and process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility
- Ensure payments and/or denials are made in accordance with company practices and procedures
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Acts as a liaison and member advocate between the member/family, physician and facilities/agencies
- Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
- Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
- Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied
Medical Receptionist II
Medical Employment Directory
St. Louis, MO
05.2016 - 03.2017
- Greets and appropriately directs patients via multi-phone calls or direct contact
- Schedules appointments and updates demographic information, checks patients in and out and collects copayments
- Insurance verification and eligibility via E-Verify
- Scans all medical documents into appropriate charting
- Distributes all mail and transmittals
- Performs general clerical duties as needed
- Performs duties and responsibilities in a professional matter
- Use various software; i.e
- Epic, Centricity, EMR and Adobe
Senior Patient Coordinator
SluCare Department of Otolaryngology/Head & Neck Cancer
St. Louis, MO
09.2013 - 04.2016
- Responsible for payment collection and posting; reviewed requisitions; prepared reports; transcribed clinical correspondence; may collaborate with billing process
- Reviewed and maintained demographic and insurance information; obtains and issues referrals in IDX and Epic EMR
- Scheduled surgeries, services, and appointments; prepared referral forms for tests, procedures, consulted with specialty physicians; obtained x-rays and test results; verified benefits and assisted with various insurance protocols; precertified tests and procedures
- Answered multi-line telephone system assisting patients with appointments and follow ups and even coordination of care with other doctors
- Insurance verification and benefits and eligibility for all patients
- Liaison between physicians and patients for all precertification and prior authorization needed for any office procedures
Patient Service Representative/Front Office Medical Assistant
BJC Medical Group
St. Louis, MO
07.2012 - 08.2013
- Triaged phone calls from patients to physicians in a timely manner and responded to each accordingly by assigning tasks
- Prepared fee tickets for proper documentation of encounters daily
- Answered a high volume of inbound calls
- Scheduled and confirmed patient appointments
- Collected and posted payments, recorded receipts and verified insurance
- Communication liaison for patient/physician relationship and requested Rx/refills for patients
- Explanation of Benefits (EOB)
- Provided expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
Education
Associates of Occupational & applied Sciences -
Allied Medical College
04.2004
Skills
- Portico
- MicroStrategy
- Amisys
- Microsoft Office
- Medicaid/Medicare Health Plans
- Omni Prod
- Excel
- CenProv
- CenPas
- CRM
- TruCare
- Prac Tools
- FileNet
- Epic
- NextGen
- Medical Manager
- Config Tracker
- Payment Index
- Analytical skills
- Problem solving
- Project Management
- MS Office
- MS Excel
- Managed healthcare
- Data Management
- Oral and written communication
- Self-management
- Detail-oriented
- Statistical analysis
- Marketplace (Ambetter)
- Multitasking
- Requirements gathering
- Team collaboration
- Data management
- Customer relationship management
- Effective communication
- Attention to detail
- Time management
References
Available upon request
Timeline
Business Analyst I
Centene Corporate
06.2022 - Current
Grievance & Appeals Coordinator I
Centene Corporate
06.2021 - 06.2022
Provider Data Management Analyst II
Centene Corporate
10.2018 - 06.2021
Customer Service Specialist/ Provider Claims Analyst Liaison II
Centene Home State Health Plan
03.2017 - 10.2018
Medical Receptionist II
Medical Employment Directory
05.2016 - 03.2017
Senior Patient Coordinator
SluCare Department of Otolaryngology/Head & Neck Cancer
09.2013 - 04.2016
Patient Service Representative/Front Office Medical Assistant
BJC Medical Group
07.2012 - 08.2013
Associates of Occupational & applied Sciences -
Allied Medical College
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