CHOMEKA JONES
Fresno,TX
Summary
Dependable, resourceful, and insightful systems analyst known for strengths in migration implementation, problem resolution, improving functionality, troubleshooting, debugging, and forward-thinking strategies. Self-managed team member able to independently analyze provider and contract data agreements. Proficient in project planning and cross functional team collaborations while maintaining data integrity. Able and ready to take on challenges using problem solving and task prioritization skills to propel team success. Identifies and bridges any knowledge gaps to offer value to employer and team. Stays on top of high demands in fast paced environments. Commended for excellent customer service and timely and accurate completion of system enhancements and migration implementation of Medical Management Information Systems such as Facets, QXNT, Athena and EPIC Tapestry. Well versed with provider abrasions during migration implementation. Acute TMHP, HHSC, PEMS, NPPES, Optum Encoder Pro, Tac (Outliers) and CMS acumen of policies, guidelines, and regulations for Managed Care Organizations. Proficient and focused on performance management of system operations and claims process efficiency.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Configuration Analyst
TEXAS CHILDREN'S HOSPITAL
Bellaire, TX
07.2022 - 05.2024
- Conducted vendor configuration builds based on vendor executed contract agreements, fee schedules, and rates according to TMHP, HHSC and CMS policies and standard regulations in EPIC/Tapestry.
- Designed and executed configuration solutions, resulting in a 20% increase in operational effectiveness.
- Implemented and led system enhancements updates to maintain data accuracy and integrity for Medicaid (Chip, Star & Star Kids) members by utilizing resources such as MCO Notices, TMHP, RFD.HHS regulatory websites, PEMS, NPPES, Optum Encounter and TAC (Outliers) to provider abrasions.
- Conducted regular regression testing reviews for configuration builds to minimize provider abrasions and complaints by more than 15% while achieving a 30% efficiency boost by maintaining up-to-date knowledge of fee schedules and annual rate updates.
- Produced CRM, Claims Impact & SQL reports, LOA's by cutting claims processing time by 20% and recoupment of funds.
- Led departmental quality standards through rigorous testing, optimizing performance and reliability by conducting quarterly testing efforts, regression testing while improving system reliability by 10%, reducing errors by more than 15%.
- Analyzed system requirements to develop systems configuration plans and procedures.
- Performed analysis on existing configurations to identify areas for improvement or optimization.
- Managed the roll-out of new applications and services such as QlikSense, Tac (Outliers), Smartsheet, Microsoft Forms and Quick Base.
- Acted as a liaison between users and IT staff when resolving complex problems related to system configurations.
Provider Installation Analyst
QlikSenseTEXASenseTEXASenseTEXAS CHILDREN'S HOSPITAL
Bellaire, TX
04.2019 - 06.2022
- Proficient in managing provider configurations using QNXT for Medicaid vendors and providers, ensuring accurate and up-to-date information on provider networks, contract details, and credentialing requirements such as adding new providers, updating existing provider information, and implementing contractual agreements within the system for (Chip, Star & Star Kids) members
- Skilled in conducting testing, validation, and ongoing maintenance to optimize provider management processes and ensure compliance with regulatory standards
- Identified process improvement opportunities through quantitative analysis, leading to a 15% reduction in processing time
- Contributed to strategies for enhanced system capacity through automation and standardization, resulting in a 20% increase in efficiency
- Trained junior analysts, improving their skills in advanced analytical techniques, resulting in a 25% increase in productivity
- Analyzed data to identify trends and patterns, enabling data-driven decision-making with a 15% improvement in provider builds, decisions, and accuracy
- Established metrics and benchmarks, tracking performance against industry standards with a 25% increase in accuracy
- Standardized business processes based on data analytics increasing process consistency and efficiency by 20%
- Utilized software tools/resources such as PEMS, NPPES, IRS website amongst others to efficiently process and analyze large datasets, improving data processing speed by 30%
- Collaborated with cross-functional teams on data analysis projects, improving project outcomes by 20% by maintaining accurate inventory records while tracking costs against budget targets, achieving budget compliance goals of 95%.
Billing Representative II
Memorial Hermann
Houston, TX
09.2017 - 04.2019
- Developed departmental procedures and best practices to ensure consistent billing for Private and Commercial insurance in Athena electronic health care system
- Met weekly billing and collections quotas through diligent payment follow-up
- Managed a high volume of daily transactions, ensuring timely processing
- Posted payments, reconciled invoices, generated billing statements and reviewed invoices and billing documents for accuracy
- Researched alternative strategies for handling high-volume billing work
- Applied analytical approaches to trace and resolve billing discrepancies.
Senior Provider Data Analyst
Aetna Healthcare
Houston, TX
12.2007 - 07.2018
- Managed provider setup and configuration for Medicaid and Medicare PFFS vendors using QNXT platform, ensuring accurate and efficient onboarding of new providers and maintenance of existing provider data
- Proficient in navigating QNXT to add new providers, update provider information, and establish contractual agreements
- Skilled in conducting testing, validation, and ongoing maintenance to optimize provider networks and ensure compliance with organizational standards and regulatory requirements
- Serve as the primary internal/external contact to identify opportunities to improve data processes and measurement strategies
- Improved operations with skilled data interpretation and results analysis using various statistical techniques
- Completed high throughput analytics using SQL
- Filtered and cleaned data with automated and manual data reviews
- Managed complex projects with high level of organization, time management and attention to detail
- Collaborated with cross-functional teams to address business challenges through data-driven solutions
- Increased usefulness of analytical reports with enhanced data mining and segmentation techniques
- Revised existing system logic difficulties to improve data accuracy and throughput
- Cleaned raw data sets, removing outliers or erroneous entries, before conducting thorough analyses
- Maintained up-to-date knowledge of industry best practices, emerging technologies, and analytics methodologies.
Education
Business Administration, Bachelor's - Applied Science
University of Houston
05-2025
AAS - Business Management/Human Resources Management Specialization -
Houston Community College
08.2020
AAS Certificate - Medical Technology -
Houston Community College
Skills
- Contract/Provider Configuration
- Teamwork and Cross-functional
- System Analysis & Reporting Collaboration
- Training & Development
- EPIC Certified
- SQL Reporting
- Strategic Planning
- Analytical Thinking
- Effective Communication
- Adaptability and Flexibility
- Reliability/Interpersonal Skills
- Business Process Improvement
- Data Analysis/Root Cause Analysis
- System Integration/Data extraction
- Business process improvement
- Configuration/Time Management
- Cybersecurity
- Windows 95/98/2000/XP/XP Pro/NT
- Information Security
- Process Mapping
- Network Administration
- Test Planning (Regression)
Certification
EPIC Certified in Tapestry Contracts and Claims Administration, 07/01/23
Timeline
Configuration Analyst
TEXAS CHILDREN'S HOSPITAL
07.2022 - 05.2024
Provider Installation Analyst
QlikSenseTEXASenseTEXASenseTEXAS CHILDREN'S HOSPITAL
04.2019 - 06.2022
Billing Representative II
Memorial Hermann
09.2017 - 04.2019
Senior Provider Data Analyst
Aetna Healthcare
12.2007 - 07.2018
Business Administration, Bachelor's - Applied Science
University of Houston
AAS - Business Management/Human Resources Management Specialization -
Houston Community College
AAS Certificate - Medical Technology -
Houston Community College
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