Yvette Jones
Summary
Dynamic Benefit Configuration Analyst committed to optimizing systems performance for reduced operational costs and streamlined workflows. Claims analysis and auditing for cost-share, accumulator, and member's benefit. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
6
6
years of professional experience
Work History
BENEFIT CONFIGURATION ANALYST
Catalyst Solutions
2022.05 - Current
- Managed Current Analysis report with Financial Impact for presentation to Stakeholders for Business Decisions
- Troubleshot incidents reported by end-users to schedule system changes and identify permanent solutions
- Collaborated with upper management to drive strategy and implement new processes
- Communicated and explained business requirements to team members to understand and implement functional demands
- Analyzed existing systems and databases and recommended enhancements to solve business needs
- Performed internal system acceptance to deliver well-tested enhancements and meet business requirements
- Managed Benefit Configuration Projects through Agile/Sprint Process.
ASSOCIATE DIRECTOR LEVEL 1, BENEFIT CONFIGURATION ANALYST
Metroplus-Health and Hospital
2020.07 - 2022.05
- Responsible for research of claims inquiry issues due to CCI edits via Clinical Healthcare Inquire, Change Health care website and CMS
- In addition, researched Fee schedule rates through CMS and EMEDNY websites
- Any Regulatory or Compliance updates, a Change Request Form is drafted for Configuration Department for review, configuration, and production implementation in SS & C Power-Stepp payer system
- Beacon/Behavioral Health In-house Project-Responsible with creation of test cases/scenarios for MetroPlus' Behavioral Department
- In a lead role, to monitor test results through Share Point and Issue Tracker for resolution
- Evaluate Pre-Implementation Change Requests-Responsible with testing pre implementation projects in Power-Stepp Model
- Report any issues or concern to Senior Benefit Configuration Coder
- Assisted senior leadership in managing all aspects of operations
- Trained and developed department leaders and management staff for specific projects and ongoing operational needs.
CONFIGURATION/BENEFIT ANALYST
Healthfirst
2018.01 - 2020.03
- Update Benefit Configuration in MHS Payer System
- Work closely with Product team from Commercial and Government departments for government and federal updates and regulations according to member's cost-shares and usage limitations on various medical services
- Analyzed explanation of coverage document, e.g., Summary of Benefits and Coverage (SBC) to assist to determine best approach for loading benefits offered including member cost share and out-of-pocket maximums
- In addition, responsible documentation gathering, data analysis, and creation of test cases for production implementation
- Cost-Saving Project: Medicare Lung Cancer Screening Benefit Implementation
- Medicare member has a cost savings in cost shares for initial Lung Cancer Screening
- Regulatory and Compliance Project: Maternal Depression Upgrade
- Compliance within Healthfirst Commercial Plans meet diagnosis codes criteria for NY State.
Education
Master of Science - Health Administration
Walden University
01.2021
Certificate - Six Sigma Green Belt
VILLANOVA UNIVERSITY
01.2020
Skills
- Analytical Thinking and Problem Solving
- Agile/Scrum Methodology
- Teamwork and Collaboration
- Software Testing and Validation
- Time Management and Organization
- End User Support
- New Feature Development
- Performance Analytics
- Project Specifications
- PC Configuration Design Development
- Configuration Review
- Gather Project Requirements
- User Acceptance Testing (UAT)
- Configuration Management
- Agile Methodologies
Healthcare Systems
Payer Systems: DST/SCC Amysis, PowerStepp, MHS, and Facet/QNXT
Timeline
BENEFIT CONFIGURATION ANALYST
Catalyst Solutions
2022.05 - Current
ASSOCIATE DIRECTOR LEVEL 1, BENEFIT CONFIGURATION ANALYST
Metroplus-Health and Hospital
2020.07 - 2022.05
CONFIGURATION/BENEFIT ANALYST
Healthfirst
2018.01 - 2020.03
Master of Science - Health Administration
Walden University
Certificate - Six Sigma Green Belt
VILLANOVA UNIVERSITY
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