Stacy Love
Chicago,IL
Summary
Discerning Computer Systems Analyst devoted to improving computer systems and network performance for enhanced productivity. Works actively with management to develop cost-benefit analyses and set objectives for system maintenance and upgrades. Stays up-to-date on latest security regulations and protocols to execute effective measures for sustaining privacy and operational integrity.
Overview
13
13
years of professional experience
Work History
HOME CARE AIDE
ADDUS HEALTH CARE
01.2011 - Current
- Assist clients with household chores
- Administer medication daily
- Accompanied clients to appointments.
Configuration Analyst
Surest-UHG Remote Contract
11.2023 - 12.2023
- Supported benefits implementation through testing, design, and information enhancement for external and internal stakeholders
- Managed fee schedule updates and contract amendments and ensured clear documentation and communication of claims configuration change requests
- Assisted in analyzing and configuring benefits, investigated configuration errors, and researched data and application-related issues for effective system maintenance.
QNXT 5.9 Version Configuration Analyst
Imagine 360, PA, Remote Contract
11.2022 - 08.2023
- Supported benefits implementation through testing, design, and information enhancement for both external and internal stakeholders
- Managed fee schedule updates and contract amendments and ensured clear documentation and communication of claims configuration change requests
- Assisted in analyzing and configuring benefits, investigated configuration errors, and researched data and application-related issues for effective system maintenance
- Involved with Medical/Hospital Claims, Encounter Claims, using EDI X12 transactions like 834, 837, 835, 270/271 & 276/277
- Supports Plans/Products and Provider Agreements configuration changes and new configuration requirements, including configuration analysis, design, build and test
- Good hands on exp with Integrated NetworX Suite to configure Provider Contracts based on business needs
- Good understanding of Provider contract language, convert into technical terms, create/update Fee Schedules, Qualifier Groups, Rate Sheets, Global Terms, Complex Terms and Reimbursement Policies.
NetworX Configuration Analyst
Catalyst Solutions
04.2022 - 10.2022
- Supports Plans/Products and Provider Agreements configuration changes and new configuration requirements, including configuration analysis, design, build and test
- Good hands on exp with Integrated QNXT 5.9 Version NetworX Suite to configure Provider Contracts based on business needs
- Good understanding of Provider contract language, convert into technical terms, create/update Fee Schedules, Qualifier Groups, Rate Sheets, Global Terms, Complex Terms and Reimbursement Policies
- Supported benefits implementation, conducting testing, design, and information enhancement for internal and external clients
- Contributed to network and hardware maintenance for application hosting
- Created rate sheets to maintain current pricing data and analyzed coverage documents for optimal benefit configuration, including member cost-sharing.
Prior Authorization Specialist
Advocate Medical Group
10.2020 - 05.2022
- Assisted patients with treatment requiring insurance pre-authorization, conducting interviews to assess medication needs and liaising with insurance and nurse managers for approval
- Verified insurance eligibility, benefits, and requirements, ensuring timely pre-authorization acquisition from carriers
- Reviewed and managed the drug authorization work queue, identifying and addressing therapy plans requiring prior authorization.
Configuration Analyst
Innovista Health
01.2020 - 05.2022
- External communication with providers to update and maintain accurate information, including provider data, terminations, changes, and contracts in the system
- Implemented Sentinel Rules Engine (SRE) for a sizeable cloud-based application, improving security and compliance
- Developed custom policies for specific security requirements using SRE
- Worked with cross-functional teams to ensure SRE policies aligned with business goals
- I know Jive's configuration and customization options, have experience with HTML, CSS, and JavaScript, and strong problem-solving and critical thinking abilities.
Configuration Analyst
Evolent Health
03.2016 - 05.2019
- Supported benefits implementation, conducting testing, design, and information enhancement for internal and external clients
- Contributed to network and hardware maintenance for application hosting
- Created rate sheets to maintain current pricing data and analyzed coverage documents for optimal benefit configuration, including member cost-sharing.
Education
Healthcare Administration -
South University
Savannah, GA01.2024
Skills
- Progress Documentation
- Client Documentation
- Care Plan Management
- Care Plan Adherence
- Search Engine Optimization
- Technical Analysis
- Organization and Time Management
- Clerical Support
- Attention to Detail
- Critical Thinking
- Good Telephone Etiquette
- Multitasking Abilities
- Dependable and Responsible
- Planning and Coordination
- Decision-Making
- MS Office
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Timeline
Configuration Analyst
Surest-UHG Remote Contract
11.2023 - 12.2023
QNXT 5.9 Version Configuration Analyst
Imagine 360, PA, Remote Contract
11.2022 - 08.2023
NetworX Configuration Analyst
Catalyst Solutions
04.2022 - 10.2022
Prior Authorization Specialist
Advocate Medical Group
10.2020 - 05.2022
Configuration Analyst
Innovista Health
01.2020 - 05.2022
Configuration Analyst
Evolent Health
03.2016 - 05.2019
HOME CARE AIDE
ADDUS HEALTH CARE
01.2011 - Current
Healthcare Administration -
South University
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