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

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, OR

06.2020

Skills

Proficient in Microsoft Office
Data Analysis
Documentation Development

User acceptance testing
Excellent Time Management
Detail Oriented

Timeline