Melanie Watson
Managed Care Software
Saint Peters,MO
Summary
Accomplished Business Consultant with a proven track record at Zyter|TruCare, enhancing software solution implementations and driving process improvements. Skilled in Microsoft Excel and adept at cross-functional collaboration, significantly improved project delivery timelines. Expertise in analytical problem-solving and effective communication, ensuring alignment with business and functional requirements.
Overview
13
13
years of professional experience
Work History
Business Consultant
Zyter|TruCare
02.2022 - Current
- Drive the functional implementation of the software solution by gathering business and functional requirements, recommending process improvements, performing testing and providing support during full implementation process
- Perform system demonstrations to customer subject matter experts in support of workflow and product alignment review efforts
- Collaborate with business sponsors and program management to define and manage the scope, requirements analysis and implementation of projects
- Gather and document workflow, both high-level and detailed, to obtain business and functional requirements in alignment with product capability, eliciting requirements using interviews, document analysis, requirements workshops, surveys, site visits, business process descriptions, use cases, scenarios, business analysis, task and workflow analysis
- Perform configuration/development and testing of the features
- Understand the Implementation Project Plan to drive functional activities to successful completion and guide the client on any implication of changing schedule and timeline
- Identify areas for process improvement within implementation process and internal initiatives to drive continuous improvement projects for implementation operations with the approach to minimize potential application changes
- Communicate with cross-functional teams to coordinate requirements, design and enhancements with the development team
- Contribute to writing specifications and design documents for the products
- Support Quality Assurance and product management to construct, manage, and execute test plans, scripts and bug identification
- Support the creation of training collateral to train super users on product interface
Manager, Medical Management Operations
Centene Corporation
07.2020 - 02.2022
- Oversee various operational objectives to assure Medicare product performance is consistent with the corporation’s business and CMS regulatory requirements
- Provide functional and technical support regarding Medicare product requirements
- Collaborate with corporate and health plan departments to effectively oversee projects, identify resources, resolve issues and mitigate risks
- Evaluate and provide process improvements to current work processes
- Facilitate development of various reporting tools to monitor operational functions and identify opportunities for improved performance, including development and analysis of reports
- Mentor and support staff
Project Manager II, Medicare Operations
Centene Corporation
02.2019 - 07.2020
- Facilitated new Medicare Health Plan implementations, delegates and confirms appropriate point person and ensures compliance for go-live
- Managed the Policy and Procedures updating for Medicare Operations team to ensure contractually compliant documents
- Responsible for CMS audit protocols and regulatory operations for Medicare Operations processes
- Assisted with developing training material and training health plan staff and new Medicare Operations staff as needed
- Designed and implemented training on managed care policies, processes and tools as well as software applications and state and federal regulations; delivered training to leadership and staff in classroom settings
- Evaluated and improved existing medical management practices across all health plans
- Utilized continuous process improvement techniques to current work processes to enable health plans and other staff to ensure compliance with state and federal guidelines
- Managed the Medicare Boot Camp training, hotel accommodations, food and technology functions
Clinical Analyst, Medicare Operations
Centene Corporation
09.2014 - 02.2019
- Analyzed CMS compliant reports monthly and weekly
- Initiated Medicare letter changes, responsible for creation, testing and verification
- Assisted with CMS Audit, ensuring policies were current, data was accurate and provided research as needed
- Lead HRA work group to update the HRA and assisted with production of paper HRA process
- Collaborated with Business Intelligence to create Care Management tracking reports to improve HRA and Care Management timeliness compliance
- Provided vendor data collections, training and relationship development
- Developed training material and trained health plan staff and new Medical Management – Medicare staff as needed
- Oversight of CMS compliant Audit Tool, initiating updates as needed
- Oversight of Medicare Audit Corrective Action Plans (CAPs) for deficient health plans
- Coordinated and assisted with CMS document creation, review and ensured timely submission
Business Analyst I, Encounters
Centene Corporation
04.2012 - 09.2014
- Supported business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
- Identified and analyzed user requirements, procedures, and problems to improve existing processes
- Lead problem solving and coordination efforts between various business units
Education
Bachelor’s Degree - Management, Accounting
University of Missouri—St. Louis
St. Louis, MOMaster’s - Business Administration
Webster University
Webster Groves, MOSkills
- Microsoft Word
- Microsoft Excel
- Microsoft Visio
- Microsoft PowerPoint
- TruCare Clinical Documentation System
- Microsoft Access
- SQL Server
- Peachtree
- NextGen
- Oracle
- Amisys Golden
- Jira
Technologyskills
- Excellent computer skills
- Microsoft Word
- Microsoft Excel
- Microsoft Visio
- Microsoft PowerPoint
- TruCare Clinical Documentation System
- Microsoft Access
- SQL Server
- Peachtree
- NextGen
- Oracle
- Amisys Golden
- Jira
- SalesForce
- Confluence
- Smartsheet
- Microsoft Project
Managed Care
Oversee and experience with CMS audits, remediation and follow-through audit evaluation.
Timeline
Business Consultant
Zyter|TruCare
02.2022 - Current
Manager, Medical Management Operations
Centene Corporation
07.2020 - 02.2022
Project Manager II, Medicare Operations
Centene Corporation
02.2019 - 07.2020
Clinical Analyst, Medicare Operations
Centene Corporation
09.2014 - 02.2019
Business Analyst I, Encounters
Centene Corporation
04.2012 - 09.2014
Bachelor’s Degree - Management, Accounting
University of Missouri—St. Louis
Master’s - Business Administration
Webster University
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