Winter Haven Senior High School

Configuration Consultant with Dell

My current duties as a Business Systems Analysis Advisor inlcudes but not limited to loading new and or amended provider contracts in the Claims Processing Platform Xcelys.  I build custom Price Rules and Price Schedules based on the terms listed in the contracts.  I also load provider and vendor demographics information provided on the Transmittal or Contract Maintenance Form.  I have an understanding of the hierarchical fall thru for Configuring a provider contract from beginning to end.  I create test claims to validate the configuration of my contracts.  This is the vast majority of what I do on a day to day basis.  However, my daily job function varies based on the needs of the project.

Dell

Business Systems Analysis Advisor

My responsibilities at Freedom Health as a Sr. Configuration Analysts were to configure and implement new markets, products as well as existing business in the IKA systems. As a Benefit Specialist I had to research and build benefit categories that coincided with the members benefit summaries.  Review Medicare guidelines to determine which services are covered versus non-covered.  Create excell spreadsheets which consisted of active benefit categories, co-payments, deductibles and authorization rules for each network.  As a Sr. Configuration Analysts I loaded new Provider Contracts released from Credentialing. I configured provider demographic, billing and payment information in the claim system while maintaining departmental quality, production goals and objectives.  I audited my peers completed assignments to insure accurate cases were being completed before parting the department.  I also documented and distributed audit error forms to the Configuration Analysts for training and accountability purposes.

Freedom Health

Sr. Configuration Analysts/Benefits Specialists

My responsibilites as a Sr. Configuration Analysts were to load and audit provider contracts into the Diamond platform.  I was also the SME when my peers needed additional assistance/training completing provider contract loads.  I resolved provider load issues within the established documented processes.  Resolved critical errors and departmental inquiries forwarded from the claims department.  Assisted and lead in various special projects which consisted of conference calls, resolution logs and updating excel spreadsheets.  I had to communicate with the Provider Relations team to resolve contractual issues.  I also Pre-Audited my peer's completed assignments to insure accurate loads prior to the case being released to the official audit department.  I also maintained high quality work while exceeding the productivity expectations.

Tikkitrest Scaife