Summary
Overview
Work History
Education
Skills
Training
Workaccomplishments
Timeline
Generic

Meg Hesser

Tampa,USA

Summary

Experienced with leveraging data analysis to inform business decisions and optimize processes. Utilizes critical thinking to identify inefficiencies and recommend practical solutions. Track record of collaborating with cross-functional teams to achieve project goals and enhance operational performance. Accomplished at leveraging past lessons to inform future decision-making. Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills.

Overview

8
8
years of professional experience

Work History

Business Analyst II—National Hospitals—Network Operations

Centene Corporation
10.2023 - Current
  • Lead cross-functional department and team auditor
  • Project Manager and point of contact for team updates
  • SAT Committee; provided expertise in department systems and National Hospital processes for various SAT resources
  • Provided team and individual-based training
  • Provider and Hospital data clean-up lead
  • National Hospital TIN List creation & management
  • Process optimization
  • Communications liaison for cross-functional departments
  • System and process Subject Matter Expert in company systems Xcelys, CenProv, TSS
  • Point of contact for root cause investigations and resolution specialist

Owner/Operator

Freelance Writer
10.2018 - Current
  • Developed an expansive portfolio on Upwork and retained multiple clients; article/blog subjects vary greatly and include introducing new medical industry procedures
  • Maintain Treat-Your-Mind.blog with mental health awareness pieces; lucid dreaming education, and well-being alternatives

Provider Data Management Analyst II—Network Adequacy—Network Operations

Centene Corporation
01.2023 - 10.2023
  • Enroll Providers into PCA and CenProv systems to reflect respective Participating Contracts in Xcelys
  • Data Maintenance for Contracted Providers, including Terminations, Change of Address, Enrollment of Practitioners, and Flat File/Roster PLFs
  • Validate Providers’ phone number and address data to provide directory adequacy through Y-Validation calls
  • Created PCA SOP resources for the Network Development Department, in both Microsoft Word and Microsoft PowerPoint
  • Point of Contact for assistance with Provider Load Form creation and processes for our team
  • Discovered Process Improvement techniques to assist with Provider Load Form submissions
  • Identified load errors for Contracted Providers that would have otherwise created provider abrasion
  • My Quality and Production was nearly double the new Production and Quality metrics set for our team for the months of June and July 2023 and on track to exceed to month of August 2023
  • Received promotion within Network Adequacy to Business Analyst II; performed higher level tasks and new responsibilities
  • Despite Centene career growth regulations, I received this promotion three months before the required one year and skipped the Business Analyst I level due to my performance

Provider Data Management Analyst I—NonPar Claims Configurations

Centene Corporation
08.2021 - 01.2023
  • Process assigned claims by cross referencing and verifying provider information for payment; prioritizing accuracy while maintaining high production to ensure our providers receive compensation in a time-efficient manner
  • Elected by management to participate in, and acquire, various department projects with Auditors and Business Analysts; projects include: 1099 Address Search, 0132 Vendor Path Error, 0730 Duplicate PID Clean Up, 027 Manual Entry, Davita/Fresenius/LabCorp NonPar PID reports, and The NonPar as Par Pricing Initiative Project
  • Help train associates on new and existing processes in order to increase team production and accuracy
  • Consistently exceed production and accuracy standards set for our department; recent production numbers have doubled the minimum required, while maintaining almost 100% accuracy
  • In closing out last year, I received an Exceeds Expectations for my current position

Member Service Representative II—Star Care South

Centene Corporation
05.2020 - 08.2021
  • Outreach members as part of the Health Effectiveness Data & Information Set campaign (HEDIS) and preventative Services Outreach (PSO); communications liaison between members and their providers to set appointments; provide health screening education
  • Participated in multiple campaigns as an advocate for at-risk members; addressed concerns related to members’ health plans and access to care
  • Periodically assist departments to address inbound calls from Dual-members when a call-influx occurs or is imminent
  • Provide education to members for optimal online-system utilization
  • Online systems including Find a Provider, Drug Formulary Search Tool, and CVS/Caremark
  • Claims and authorization education for WellCare members

SAM Processing Specialist – Application Processing

Select GCR
10.2019 - 03.2020
  • Exceeded production expectations by becoming the subject matter expert in SalesForce application, optimizing entry process and processing 100+ SAM files daily
  • Became subject matter expert on Dun & Bradstreet, IRS, and DLA/CAGE department compliance to ensure all leads contain accurate business information
  • Collaborated between sales agents and clients to finalize application process with limited submission errors

SAM Processing Specialist – Publications

Select GCR
01.2019 - 03.2020
  • Partnered with IT to utilize Google Search statistics for weekly article production; integrate Search Engine Optimization keywords for preeminent Google search ranking
  • Industry research and content development; authored company articles; Social media management

Project Management

Health-Connect LLC
01.2017 - 10.2018
  • Coordinated a cross functional daily workgroup to identify new business ventures
  • Completed Market Research on selected ventures; presented research to CEO/Partners for final decision
  • Became leader in Pharmacy Software venture including Sales, Contract Negotiations, and front-line client support

Education

High School Diploma -

J.W. Mitchell High School
New Port Richey, FL
08.2009

Esthetician -

Bene’s School of Cosmetology
Port Richey, FL
08.2010

Skills

  • Adobe Photoshop
  • Customer Service
  • Client Conflict Resolution
  • Process Optimization
  • Data Analysis
  • Contract Specialist
  • Excel
  • Jira
  • SalesForce
  • SQL
  • TSS Reports
  • Microsoft Suite
  • Adobe Acrobat Professional
  • Comprehensive Writing
  • Tableau
  • PowerBI
  • Microsoft Office Suite
  • Project Management
  • Requirements Gathering
  • User Acceptance Testing

Training

  • Excel: Pivot Tables, Dashboards, Macros & Micros, Advance Formulas
  • PowerBI
  • Tableau
  • SQL
  • Snowflake

Workaccomplishments

  • Initiated access for associates on CAQH.
  • Performed Hospital data cleanup and communicated with hospital contacts.
  • Advised management on task appropriateness for team auditing.

Timeline

Business Analyst II—National Hospitals—Network Operations

Centene Corporation
10.2023 - Current

Provider Data Management Analyst II—Network Adequacy—Network Operations

Centene Corporation
01.2023 - 10.2023

Provider Data Management Analyst I—NonPar Claims Configurations

Centene Corporation
08.2021 - 01.2023

Member Service Representative II—Star Care South

Centene Corporation
05.2020 - 08.2021

SAM Processing Specialist – Application Processing

Select GCR
10.2019 - 03.2020

SAM Processing Specialist – Publications

Select GCR
01.2019 - 03.2020

Owner/Operator

Freelance Writer
10.2018 - Current

Project Management

Health-Connect LLC
01.2017 - 10.2018

High School Diploma -

J.W. Mitchell High School

Esthetician -

Bene’s School of Cosmetology

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Meg Hesser