Summary
Overview
Work History
Education
Skills
Accomplishments
Software
Timeline
AssistantManager

Tamara Woody

Senior Business Analyst
Paducah,KY

Summary

Senior Business Analyst with15+ years of healthcare industry experience specializing in provider reimbursement, Medicaid/Medicare compliance, and process improvement. Proven ability to lead cross-functional teams, streamline operations, and enhance system implementations for healthcare providers and payers.

Overview

16
16
years of professional experience

Work History

Senior Business Analyst

Evolent Health
12.2021 - 05.2024
  • Provider Reimbursement/Implementation
  • Acted as Lead for Client Implementation
  • Defined and documented business requirements for state Medicaid and CMS programs, ensuring100% compliance with provider reimbursement policies
  • Worked closely with the partner and business operations team to develop and evaluate business requirements to determine the most efficient implementation of clinical editing and provider pricing reimbursement methodologies
  • Managed the provider Reimbursement inventory for all clients
  • Managed pricing ticket interpretations and updated with any missed requirements
  • Triaged pricing tickets for accuracy of requirements and remediate gaps found
  • Researched, interpreted, and summarized state and/or CMS regulations related to Medicaid, Medicare Advantage, and Exchange programs with an emphasis on provider reimbursement functions
  • Performed requirements review with external and internal stakeholders and obtain sign-off from all required individuals
  • Managed Business Requirements Documents deadlines with necessary tools for completion tracking and clearly identifying open items that need inputs from stakeholders
  • Managed workflow and communication with the provider reimbursement intelligence platform vendor to ensure timely and accurate implementation of provider contracts and pricing edits
  • Built and maintained any business and workflow documentation needed to support provider reimbursement process
  • Collaborated with internal and external stakeholders to gather requirements pertaining to provider functions
  • Provided executive reporting on status of contract completion and maintained upward communication on any roadblocks
  • Created and standardized business requirements documentation processes and workflows
  • Identified issues upfront and communicated clearly to management
  • Participated in the management of the provider reimbursement intelligence platform vendor
  • Managed reports for proper prioritization of work with provider reimbursement intelligence platform vendor
  • Ensured continuing operational support by documenting changes and enhancements
  • Provide training to staff on an as-needed basis and act as a mentor for new team members

Sr Analyst

Molina Healthcare Dba Passport Health Plan
01.2021 - 11.2021
  • Responsible for contract review and direction on set up
  • Managed all provider discrepancies/updates
  • Worked alongside Provider Configuration Management & Contracting for provider updates
  • Reviewed coding edits to determine accuracy of claim denials
  • Completed analysis for claims reprocessing

Sr Analyst

Passport Health Plan/Evolent Health
03.2008 - 12.2020
  • Provider Reimbursement, Sr Analyst
  • Identified reimbursement methodologies for all provider types
  • Developed, implemented, and evaluated policies and processes related to the communication of reimbursement methodologies
  • Updated and maintained service codes, provider types and fee schedules as well as development and monitoring of policies related to reimbursement, fee schedules and service codes
  • Completed quality auditing of contracts to ensure claims payment accuracy, contractual compliance in support of zero tolerance for payment errors
  • Performed monthly and quarterly audits of fee schedules to ensure reimbursement is in line with DMS and CMS reimbursement methodologies
  • Performed cost analysis and tracked claims trends in utilization to provide feedback for quality improvement and cost reductions
  • Provided training related to reimbursement and fee schedule
  • Audited provider contracts through claims adjudication
  • Managed provider appeals for correct coding
  • Manually priced drugs using Reimbursementcodes.com and/or EncoderPro
  • When Passport Health Plan was bought by Evolent Health in2016, I gathered all requirements and documents for all provider types, facilities and physician offices to ensure proper configuration
  • This involved the following:
  • Documents / Requirements gathering
  • Assisted in writing the Business Requirement Document to ensure all the configuration needs were met
  • Created pricing templates for every provider contract in the system, as well as non-participating providers, to ensure proper configuration
  • Created tickets to ensure the pricing vendor received the requirements correctly
  • Created test claims to test configuration set ups

Education

Paducah Tilghman High School
Paducah, KY

Business Studies

University of Louisville
01.2005

Coursework in Healthcare Administration

Jefferson Community & Technical College
01.2005

Business Courses

KCTC
01.1995

Skills

  • Technical Skills: Claims management systems, reimbursement intelligence platforms, CMS/Medicaid/Medicare compliance, Excel (advanced), SQL, EncoderPro, Reimbursementcodescom, Scrum, Agile
  • Citrix
  • Aldera
  • QNXT
  • Power BI
  • Facets
  • JIRA
  • Jiva
  • Streamline
  • Professional Skills: Payment Integrity, provider reimbursement, process improvement, stakeholder collaboration, workflow optimization, executive reporting, impact analysis, Configuration (Implementation and Maintenance)
  • Requirements gathering
  • Agile methodology
  • User acceptance testing
  • Stakeholder management

Accomplishments

  • Spearheaded the implementation of provider reimbursement systems for multiple Medicaid/Medicare programs, improving accuracy.
  • Designed and standardized business requirement documentation processes, reducing errors in configuration setups.

Software

JIRA, Facets, QNXT, MACCESS, Power BI, Excel, Microsoft Outlook, Microsoft Word, SQL, Access, Aldera, JIVA, EXP

Timeline

Senior Business Analyst

Evolent Health
12.2021 - 05.2024

Sr Analyst

Molina Healthcare Dba Passport Health Plan
01.2021 - 11.2021

Sr Analyst

Passport Health Plan/Evolent Health
03.2008 - 12.2020

Business Studies

University of Louisville

Coursework in Healthcare Administration

Jefferson Community & Technical College

Business Courses

KCTC

Paducah Tilghman High School

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Tamara WoodySenior Business Analyst