Sherry-Ann Duhamel
Nashua,NH
Summary
Dynamic Business Process Analyst with a proven track record at United Healthcare, excelling in data analysis and customer service. Successfully improved database accuracy and efficiency, enhancing stakeholder engagement. Recognized for effective time management and commitment to continuous improvement, driving strategic initiatives and delivering results in high-pressure environments.
Overview
29
29
years of professional experience
Work History
Business Process Analyst
United Healthcare
04.2019 - Current
- Ensured high-quality service for customers both in face-to-face meetings and phone conversations.
- Ensured accuracy and consistency by updating databases with current information.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Performed in-depth research combined with thorough data analysis for strategic initiatives.
- Handled challenges in a timely and competent manner.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Worked with cross-functional teams to achieve goals.
Provider Data Specialist
United Healthcare
Nashua, NH
01.2007 - 04.2019
- Researches and verifies requests for the creation of non-par provider records from a variety of sources
- Assists in the clean up of the current provider databases, including verifying and correcting typographical errors and adding missing information such as provider specialties
- Enters new providers into the system and maintains provider data in Pulse on an ongoing basis
- Updates provider information through the re-credentialing process
- Performs review and audit of roster provider data for publication as requested
- Acts as a liaison with providers and internal departments to update provider information
- Resolves provider database issues such as addresses, fee schedules, etc
- And makes corrections as needed
- Communicates effectively with other departments within Oxford and externally with providers who require precise database information in order to ensure claims are paid correctly
- Verifies billing addresses and updates, tax IDs and group affiliation corrections, and/or general provider database clean up
- Meets established productivity and quality standards with little or no supervision
- Takes responsibility and ownership for assignments and projects in a timely and accurate manner
- Performs other projects and duties as assigned
Processor I – Claims
OXFORD HEALTH PLANS
Nashua, NH
01.2005 - 01.2007
- Process Behavioral Health, Default and Outpatient physician, hospital and ancillary claims in an accurate and timely manner
- Interprets and applies on-line payment and policy documentation correctly
- Checks for authorizations and eligibility including in-network, out-of-network, co-pays and deductibles
- Interprets contracts and makes payment directives
- Knowledge of business, products, services, CPT codes, diagnosis codes, ICD-9 codes and medical terminology
- Works with other Oxford departments via Service Request System to adjudicate claims timely (i.e., Enrollment, Medical Management, Clinical, Physician Reimbursement, etc.)
- Executes decision-making and ensures quality
- Identifies potential fraudulent claims and executes Referral Form to Special Investigations Unit
Entry Operator I
OXFORD HEALTH PLANS
Nashua, NH
01.2002 - 01.2003
- Data Entry operator responsible for keying medical claims with both accuracy and speed, while maintaining consistency and meeting company goals
Accounts Payable Clerk
TERADYNE CONNECTION SYSTEMS
Nashua, NH
01.1996 - 01.2002
- Reviewed, resolved and released payment for incoming invoices in a fast paced, high volume environment
- Created weekly and monthly internal accounts payable reports
- Performed data entry, and verified and paid employee expense reports
- Assisted employees and vendors with payables issues
- On a project basis, periodically assisted the cost accounting department with inventory to include random audits of multiple sub-inventories and verification of transactional integrity
- Reviewed results with individual management teams
- Working with a member of the IT department, created a new version of a spreadsheet that for the first time entered data into the correct fields and automatically calculated all totals
- This dramatically reduced the time needed to calculate and review expense reports
- Initially hired as an assembler in manufacturing
- Responsible for both assembly and data entry
- Because of successes in that job was selected for a position in accounts payable
Education
Diploma -
Nashua Senior High School
Nashua, NHSkills
- Data analysis
- Database management
- Continuous improvement
- Customer service
- Stakeholder engagement
- Team collaboration
Timeline
Business Process Analyst
United Healthcare
04.2019 - Current
Provider Data Specialist
United Healthcare
01.2007 - 04.2019
Processor I – Claims
OXFORD HEALTH PLANS
01.2005 - 01.2007
Entry Operator I
OXFORD HEALTH PLANS
01.2002 - 01.2003
Accounts Payable Clerk
TERADYNE CONNECTION SYSTEMS
01.1996 - 01.2002
Diploma -
Nashua Senior High School
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