Sr Consultant

Posted on: 2006-02-01

Georjean Brown 2927 Banyan Hills Lane Land O' Lakes, Florida 34639 813-385-0732 [email protected] Objective Innovative problems solver with highly complemented analytical skills. Tenacious follow-through, strong work ethic and leadership skills. I am seeking to share these assets with a progressive, quality-driven organization. Work Experience Sr Consultant 9/2005 - 1/2006 eHealthPartners, Atlanta, Georgia  Consultant for QMACS & QNXT system upgrades, implementations and process improvements.  EDI expertise with 834, 837i, 837p, 278, etc.  Understanding of QNXT database architecture for reporting and data mapping projects.  Implementations with McKesson claim check  Medicare, Medicare Part D, Medicaid and commercial knowledge.  Contract work for Molina - Long Beach ,Ca and Capital Health, Tallahassee, Florida Claims Manager to Sr System/Business Analyst 2/2000 - 6/2005 Schaller Anderson, Phoenix, Az  Provide the business with expertise and consultative support across multiple applications and for various corporate initiatives.  Planning for, developing, and managing the quality and productivity of production (claim) teams.  Coordinating site-wide issues with the site Director  Fostering and maintaining a collaborative relationship with internal and external customers to ensure customer satisfaction and profitability.  Working with business partners to identify ways to improve business processes.  Assisting in building, reviewing and adhering to the annual business plan  Controlling expenses and increasing profitability via productivity and quality gains  Reviewing team’s work results and pattern of handling claims queues and adjustments.  Partnering with supervisors to ensure teams are meeting production and quality metrics.  Providing strategic guidance for the production organization  Playing a leadership role by implementing action plans to increase quality and productivity.  Developing, motivating, and retaining employees.  Provide regular performance feedback.  Aptitude for problem solving and conducting research.  Implementations with McKesson claim check, Futurevison, aboveHealth, iHEalth vendor applications  Knowledge of PBM industry and process.  Experience working with Clearinghouses (WebMD, SPSI, Softrix,Medifax,NDC)  Disease Management systems and reporting for NCQA.  KPMG audit documentation and review.  Payer system auditing for State and Federal requirements.  Required both broad and in-depth knowledge of business and highly developed analytical skills to perform and resolve the most complex, intricate inquiries and derive trends and uncover data anomalies.  Support Hedis, Disease Management, Patient studies with data imports, reporting and analysis.  Create Business requirements.- Key resource with SAS70 audit for Operations and EDI  Create and execute test criteria documents for new and existing applications.  Interpreted analytic results including identification of factors affecting health plan performance.  Daily involvement with EDI using HIPAA, NSF and proprietary scanning formats relating to claims data and eligibility.  Respected business and working relationships with EDI vendors, Providers and Hospitals in relation to resolving complex problems and issues.  Medicaid, Medicare and Commercial proficient, review of RFP and benefits to correctly advise on system set-up, coding requirements, reporting and testing.  Considered expert user of QMACS & QNXT.  Lead projects assuring compliance with standards and specifications  Leadership/Communication skills.  Quality Control  Development and Project management.  Trend analysis and ad-hoc reporting.  Proficient understanding of Abovehealth, Ihealth, Futurevision Senior Business Analyst/Operations Specialist 7/1996 - 7/1999 National Data Corp-Health Information Services, Phoenix, AZ  Provide the application and business with expertise and consultative support across multiple applications.  Required both broad and in-depth knowledge of business and highly developed analytical skills to perform and resolve the most complex, intricate inquiries and derive trends and uncover data anomalies  Support patient studies with data analysis, data enhancement and reporting.- Create Business requirements.  Create and execute test criteria documents for new and existing applications.- Coach and mentor staff.  Lead projects assuring compliance with standards and specifications  Production processing.  Leadership/Communication skills.  Quality Control.  Development and Project management. Quality Analyst/Training Coordinator 1/1994 - 5/1996 Blue Cross/Blue Shield New Mexico, Alb, NM  Train new and existing employees on technical skills, quality servicing skills, claims processing procedures and policy interpretation  Coordinate and schedule all training classes.  Provide guidance concerning analytical skills, problem solving, errors, etc  Communicate evaluations verbally and in writing, of employee performance, including recommendations for additional and /or modified training and counseling  Develop system for evaluating trainees' competencies.  Identify problems and issues involving system processing and workflows. Propose solutions and coordinate resources for resolving  Develop, compile, organize and write instructional material.  Make formal presentations of training material to internal & external clients.  Project Management & Consultant for New product development and implementation  Project management of system enhancements.  Create and execute User acceptance testing  Extensive knowledge of Managed Care products, including Medicare and Medicaid  Development of reports for upper management.  Strong knowledge of various claims processing systems. Quality Analyst / Trainer 2/1989 - 1/1994 Cigna, Visalia, Ca & Alb/NM  Duties here are reflected and detailed above with Blue Cross/Blue Shield NM. Quality Analyst/Trainer 1/1985 - 1/1989 Blue Cross/Blue Shield of Oregon, Portland, OR  Duties here are reflected and detailed above with Blue Cross/Blue Shield NM. Education 2000 – 2006 Microsoft SQL 1998 Oracle - SQL/Plus, Phoenix, AZ 1998 Software Process Framework Methodology, Phoenix, AZ 1997 QMF ( Query Management Facility), Phoenix, AZ 1997 Computer Horizons Corp.(ACCESS), Phoenix, AZ Access 7.0 Advanced - Certificate Access for Developers - Certificate Visual Basic Fundamentals - Certificate 1997 SAS Institute, Phoenix, AZ SAS Fundamentals: A Programming Approach Certificate & SAS Advanced Processing Workshop Certificate 1996 Compuware File-AID, Phoenix, AZ 1996 System Application Architecture, Phoenix, AZ 1995 Presentation Skills seminar, Alb, NM 1995 Learning Styles of the Adult Learner, Alb, NM 1995 How to Prepare & Write Documentation, Alb, NM 1995 Facilitation Skills Seminar, Alb, NM 1995 Learning International- Quality Service Skills, Alb, NM Certified trainer for 'Quality Service Skills' 1995 Coaching Seminar, Alb, NM 1994 Train-the-trainer, Alb, NM 1994 PMBOK(Project Management Body of Knowledge), Alb, NM 1992 Company Reorg Training Seminar, Richmond, Ca 1989 LOMA, Sacto, CA 1989 HIAA, Sacto, Ca 9/1976 MTI Business College, Sacto, CA Accounting & Computer Programming 1975 American River College, Sacto, Ca  Business Management 6/1973 Mira Loma, Sacto, CA  High School or equivalent Skills Access DB2/Oracle Easy Trieve excel File Aid ICD9/CPT codes ISPF/TSO Microsoft Office Microsoft Power Point Microsoft Project Microsoft SQL server NT/95/98 Project Management QMF SAS SQL Plus Team Manager Visio