Tammy Morgan
Salt Lake City,UT
Summary
Healthcare and PBM Analyst with extensive experience in system configuration and quality assurance testing. Proficient in analyzing claims processing issues and implementing solutions that improve efficiency. Strong ability to collaborate with IT teams to enhance system functionality and user experience.
Overview
14
14
years of professional experience
Work History
BCA Analyst II
Navitus
Appleton, WI
05.2024 - Current
- Analyzed system requirements to develop systems configuration plans and procedures, most recently the AEZIPS and Specialty RPT projects and provided training and support to staff on new system functionality for AEZIPS RPT
- Analyzed configuration requirements for system updates and enhancements, including formulary, networks, and plan/benefit configurations, to ensure alignment with operational needs.
- Conducted quality assurance testing on system configurations before implementation.
- Performed UAT on AEZIPS Project to validate system requirements and user needs.
- Investigated issues with incorrect or incomplete system configurations, providing actionable recommendations for corrective measures, including GEMS system.
- Managed bi-annual TX updates and MU submissions through 3D analysis, ensuring compliance and accuracy in reporting.
Facets Claims Specialist- Tech Support Dept
Central States Funds
02.2021 - 10.2023
- Troubleshot claims processing issues by analyzing data, identifying root causes, and implementing solutions to enhance efficiency and accuracy.
- Collaborated with cross-functional teams to address and resolve complex claims-related challenges, fostering effective communication and cooperation across departments.
- Coordinated with IT staff to implement application improvements, including system enhancements and user interface updates, improving system functionality and user experience.
- Developed macros using Macro Express to automate repetitive tasks, resulting in 10% of all claims adjudicated by macros.
- Conducted ad hoc queries to identify claims issues and provided user support, presenting findings to COE team for further action.
- Planned, executed, and documented test cases for comprehensive testing of claims processing systems, identifying and resolving issues and discrepancies.
Product Management Specialist
Evolent Health, Beacon Hill Staffing
04.2018 - 05.2019
- Coordinated enhancement requests for Aldera's core platform, aligning initiatives with business objectives and prioritizing stakeholder needs.
- Collaborated closely with customers to gather comprehensive business requirements, ensuring thorough understanding of their needs and objectives.
- Developed clear written explanations for business problems by breaking down product concepts into user stories, facilitating effective communication between technical and non-technical stakeholders.
- Provided direction and support to system analysts, software engineers, and quality analysts throughout development and testing phases of enhancement specifications, ensuring smooth project execution.
- Ran scrum meetings, monitoring product development progress at predefined checkpoints and facilitating agile processes for efficient project delivery.
- Utilized Salesforce, Jira, and Speclog for tracking enhancements, ensuring accurate documentation and supporting effective project management.
- Researched impacts of governmental regulations on software, delivering detailed summaries and actionable recommendations to stakeholders.
Configuration Analyst
Select Health
10.2012 - 07.2015
- Configured, tested, and uploaded data for Medicare, Medicaid, Dental, and Commercial lines of business (LOB), ensuring accuracy and compliance with regulatory requirements.
- Implemented and maintained system changes for plan/product additions, modifications, and NetworkX, along with contracts/pricing updates, ensuring system integrity and alignment with business objectives.
- Developed and executed backend data loads using Access and SQL to facilitate seamless data transfer into Facets system, optimizing data management processes and improving efficiency.
- Provided crucial support in troubleshooting applications within Trizetto's Facets software, resolving issues promptly to minimize downtime and ensure uninterrupted operations.
- Conducted research and analysis of claims and configuration issues, identifying root causes and implementing solutions to enhance system performance and user experience.
- Led testing for Facets service pack upgrades, including quarterly fixes, ensuring thorough validation of system enhancements.
- Analyzed and reported data through table queries within Facets data warehouse, providing valuable insights to support decision-making and drive business improvements.
Education
Bachelor of Arts - English Literature
University of Utah
Salt Lake City, UT05-1995
Skills
- Configuration Management
- Claims processing software
- SQL and 3D proficiency
- System integration analysis
- Agile project management
- IT interface
Timeline
BCA Analyst II
Navitus
05.2024 - Current
Facets Claims Specialist- Tech Support Dept
Central States Funds
02.2021 - 10.2023
Product Management Specialist
Evolent Health, Beacon Hill Staffing
04.2018 - 05.2019
Configuration Analyst
Select Health
10.2012 - 07.2015
Bachelor of Arts - English Literature
University of Utah