NENIA CASTILLO
Hillsboro,OR
Summary
Detail-oriented Business Systems Analyst with a focus on continued professional growth aiming to leverage analytical skills in a full-time Quality Assurance Analyst role in Risk Management.
Overview
16
16
years of professional experience
Work History
Business Systems Analyst
Cambia Health Solutions
Portland, OR
07.2021 - Current
- Execute comprehensive plan reconciliation validations annually to mitigate CMS Edge Server rejections.
- Update pre/post submission edits for ACA and MA CMS submission based on detailed data analysis.
- Perform UAT using story cards developed by the team, as well as UAT for system upgrades.
- Identify opportunities for process improvements and efficiency.
- Engage actively in RADV audit process.
- Participate as a back up in weekly job aid review and meetings.
Provider Reimbursement Configuration Analyst
Moda Health
Portland, OR
11.2020 - 07.2021
- Performed analysis of provider contracts to establish business requirements.
- Designed and created qualifiers in Facet's to assure appropriate services priced correctly
- Researched and resolved issues referred from Claims and other various departments
- Documented processes to ensure quality standards were met.
Claims Analyst II
Tuality Health Alliance
Hillsboro, OR
01.2009 - 07.2020
- Ensured appropriate payment rates through collaboration with the Data team on QA testing.
- Performed QA testing on department system upgrades
- Audited overpaid Medicaid claims to ensure Health Share compliance.
- Assisted in the development and documentation for processes and procedures in the claim's department
- Trained new hires in both Claims Analyst I and II roles.
Education
B.S - Information Technology
Oregon Institute of Technology
Wilsonville, OR06.2020
Skills
- Proficient in Microsoft Office
- Data Analysis
- Documentation Development
- User acceptance testing
- Excellent Time Management
- Detail Oriented
Timeline
Business Systems Analyst
Cambia Health Solutions
07.2021 - Current
Provider Reimbursement Configuration Analyst
Moda Health
11.2020 - 07.2021
Claims Analyst II
Tuality Health Alliance
01.2009 - 07.2020
B.S - Information Technology
Oregon Institute of Technology
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