Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
SlideShare a Scribd company logo

Laurie Maxwell Resume 07/2016

•Download as DOC, PDF•
•
L
Laurie Maxwell

I am a customer focused technical resource who is seeking full time employment in the greater Atlanta area. I am a problem solver with a proven record for success.

Related slideshows

e-MedSolution
e-MedSolutione-MedSolution
e-MedSolution
 
Healthcare Data Quality & Monitoring Playbook
Healthcare Data Quality & Monitoring PlaybookHealthcare Data Quality & Monitoring Playbook
Healthcare Data Quality & Monitoring Playbook
 
CMS’ New Interoperability and Patient Access Proposed Rule - Top 5 Payer Impacts
CMS’ New Interoperability and Patient Access Proposed Rule - Top 5 Payer ImpactsCMS’ New Interoperability and Patient Access Proposed Rule - Top 5 Payer Impacts
CMS’ New Interoperability and Patient Access Proposed Rule - Top 5 Payer Impacts
 
1 of 2
Laurie D. Maxwell Email: LaurieMaxwell@yahoo.com 404-285-6586 (cell) Skills  Experienced in SQL Oracle and T-SQL SQL queries and table driven databases. (SQL Developer and SQL Server Management Studio programs)  Maintained and monitored daily data receipt tracking and processing for timeliness and Service Level Agreements  Numerous Data Investigations regarding clinical suites and measures and placement for HEDIS scoring  Experienced in Electronic Data Warehousing (EDW) and Cognos Impromptu software for EDW (SQL) Inquiry.  Extensive experience with CPT, ICD9, HCPCS and facility revenue medical coding terminology.  Expert in HL7 formats and data transmissions.  Current and informed regarding Blue Cross Association’s Attribution reporting due mid 2015.  Expert in Business Objects for data analysis, reports and mapping of universes  Experienced in FoxPro and Crystal Reports report writing applications.  Expert in all Microsoft Windows programs including Access, Excel, Word and Word Perfect, Power Point, Outlook, MS Project, Publisher, Visio, Adobe Acrobat and Web applications  Experience with regulatory compliance for HIPAA, SOX, HEDIS and ISO17799  Extensive experience in Geo Access programs including Geo Referral and Geo Directory  Skilled in ASA Caps, Erisco, NASCO and Amisys claims systems and HBOC Credentialing system.  Experience with McKesson Claim Check software including “Clear Claim Connection” Strengths Excellent PC knowledge and customer service skills with extensive experience in written and verbal communications. Excellent analytical and organizational skills. Creative approaches to teaching technical processing techniques and analytical logic. Creative problem solving skills. Highly motivated and goal oriented, accurate, thorough and precise in attention to details. Excellent communication skills to and from programmers to end-users. Completed Project Management Methodology training and AMA Time Management Training. Extensive experience in technical support and statistical reporting. Extensive knowledge of Medical Terminology and Procedures including coding and billing processes. Professional Experience SENIOR DATA ANALYST / QA ENGINEER III 04/14 to 06/16 Symphony Performance Health Analytics Alpharetta, Georgia MDdatacor was purchased by SPH Analytics. Researched structured clinical data files and created queries for data validation for statistical reporting. Reviewed medical traits for data integrity and clinical accuracy. Extensive use of SQL Developer in an Oracle based database. Reviewed query outputs for data integrity and quality assurance. Created monthly management dashboards that showed membership trends and clinical suite trends for each of our sponsor clients. When moved into the I.T. department, I began Wiki documentation for T-SQL Stored procedures and functions. Performed User Acceptance Testing (UAT) on newly coded functions for accuracy. Verified conversion of tables from Oracle to SQL Database functionality. DATA ANALYST TEAM LEAD 09/04 to 04/14 MDdatacor Alpharetta, Georgia Reviewed large amounts of unstructured data to determine best processing practices on the proprietary MDdatacor “Splitting and Parsing” software. Reviewed thousands of text files while maintaining accuracy and efficiency under the HIPAA guidelines concerning personal medical information and the parsing of this information. Trained new Data Analysts in use of the MDdatacor proprietary software and analytical principles. Created training documentation for statistical sampling and analyzing clinical data. Researched clinical unstructured text and created rules for data validation to create scenarios for statistical reporting. Reviewed medical traits for data integrity and clinical accuracy. Extensive use of Access and Business Objects for customer reports and clinical trial rosters. Reviewed report output for data integrity and quality assurance. Assisted with development of the “MDdatacor Data Care Center” for the Health Insurance Industry payer community. Resume Laurie Maxwell Page 1 of 2
SR. USER APPLICATIONS ANALYST II 02/01 to 06/04 Blue Cross Blue Shield of Georgia Atlanta, Georgia Ran extensive Cognos reports for claims data from the Electronic Data Warehouse (EDW) systems. Developed functional business requirements and translated them into system requirement specifications. Analyzed claims data for patterns and trends to formulate recommendations for process improvement and automation. Created user acceptance testing (UAT) scenarios for logic and benefit changes. Served as Project Lead and successfully implemented over 80 accounts onto the main frame system. Maintained all project documentation including project plans, issue logs and test scenario scripts. Developed financial processes documentation in accordance with the Sarbanes-Oxley federal mandate. Integral part of raising the Claims First Pass Rate from 63.41% to 71.94%. Assisted auditing department with mapping and identification of critical fields within EDW historical claims data. Automated a full benefit library for all accounts within the NASCO system. Administered security and maintenance of the online benefit inquiry and online help applications for the entire NASCO division of BCBSGA. PROJECT COORDINATOR 03/99 to 01/01 National Account Service Company (NASCO) Atlanta, Georgia Served as Implementation Project Lead for over 90 new accounts for the BC/BS Plans. Coordinated with Blue Cross and Blue Shield Plans across the nation on negotiating and implementing system changes. Created user acceptance testing (UAT) scenarios for all implementations. Completed user acceptance testing and maintained project issue logs and test scenario scripts. Worked extensively with Project Management Methodology (PMM) phases and documentation including problem analysis, business need, and cost and feasibility studies to determine the most effective solutions. Calculated Return on Investment (ROI) and documented full life cycle of small to medium projects. Served as liaison between the technical vendors (EDS and IBM) and the customer. NETWORK SERVICES REPRESENTATIVE 11/97 to 03/99 Medicare Secure Choice Atlanta, Georgia Managed a FoxPro database for over 2500 providers. Also, managed a Microsoft Access database for over 1000 out of area providers for possible expansion. Coordinated provider information for credentialing, marketing, enrollment, member services and administration. Administered all reports and tables for HCFA, HEDIS and NCQA guidelines and audits. Produced all reports for all business needs in the company. Reviewed report output for integrity of data. Developed, maintained and published the network provider directory. CUSTOMER SERVICE REPRESENTATIVE 03/94 to 11/97 Connecticut General Life Insurance Co. Atlanta, Georgia Handled in excess of 70 calls per day regarding the processing of HMO health claims. Educated members on all guidelines and protocols of managed care programs including Medicare and coordination of benefits. Extensive communications with members and providers. Creative problem solving regarding provider contract issues and electronic claims submission issues. Handled all appeals and grievances for the Florida healthplans. Training & Education Regulatory Compliance Security Training MDdatacor March 2006 to June 2016 Business Objects 6.5 “Intermediate Reporting” Business Objects SA July 2005 Diversity in Business WellPoint August 2003 HIPAA Policies & Security WellPoint June 2003 MS Project 98 ExecuTrain April 2000 Total Time Management Padgett Thompson AMA January 2000 Project Management Methodology NASCO November 1999 Dekalb Community College/Dekalb Technical School Certificate in Accounting Resume Laurie Maxwell Page 2 of 2

More Related Content

Laurie Maxwell Resume 07/2016

  • 1. Laurie D. Maxwell Email: LaurieMaxwell@yahoo.com 404-285-6586 (cell) Skills  Experienced in SQL Oracle and T-SQL SQL queries and table driven databases. (SQL Developer and SQL Server Management Studio programs)  Maintained and monitored daily data receipt tracking and processing for timeliness and Service Level Agreements  Numerous Data Investigations regarding clinical suites and measures and placement for HEDIS scoring  Experienced in Electronic Data Warehousing (EDW) and Cognos Impromptu software for EDW (SQL) Inquiry.  Extensive experience with CPT, ICD9, HCPCS and facility revenue medical coding terminology.  Expert in HL7 formats and data transmissions.  Current and informed regarding Blue Cross Association’s Attribution reporting due mid 2015.  Expert in Business Objects for data analysis, reports and mapping of universes  Experienced in FoxPro and Crystal Reports report writing applications.  Expert in all Microsoft Windows programs including Access, Excel, Word and Word Perfect, Power Point, Outlook, MS Project, Publisher, Visio, Adobe Acrobat and Web applications  Experience with regulatory compliance for HIPAA, SOX, HEDIS and ISO17799  Extensive experience in Geo Access programs including Geo Referral and Geo Directory  Skilled in ASA Caps, Erisco, NASCO and Amisys claims systems and HBOC Credentialing system.  Experience with McKesson Claim Check software including “Clear Claim Connection” Strengths Excellent PC knowledge and customer service skills with extensive experience in written and verbal communications. Excellent analytical and organizational skills. Creative approaches to teaching technical processing techniques and analytical logic. Creative problem solving skills. Highly motivated and goal oriented, accurate, thorough and precise in attention to details. Excellent communication skills to and from programmers to end-users. Completed Project Management Methodology training and AMA Time Management Training. Extensive experience in technical support and statistical reporting. Extensive knowledge of Medical Terminology and Procedures including coding and billing processes. Professional Experience SENIOR DATA ANALYST / QA ENGINEER III 04/14 to 06/16 Symphony Performance Health Analytics Alpharetta, Georgia MDdatacor was purchased by SPH Analytics. Researched structured clinical data files and created queries for data validation for statistical reporting. Reviewed medical traits for data integrity and clinical accuracy. Extensive use of SQL Developer in an Oracle based database. Reviewed query outputs for data integrity and quality assurance. Created monthly management dashboards that showed membership trends and clinical suite trends for each of our sponsor clients. When moved into the I.T. department, I began Wiki documentation for T-SQL Stored procedures and functions. Performed User Acceptance Testing (UAT) on newly coded functions for accuracy. Verified conversion of tables from Oracle to SQL Database functionality. DATA ANALYST TEAM LEAD 09/04 to 04/14 MDdatacor Alpharetta, Georgia Reviewed large amounts of unstructured data to determine best processing practices on the proprietary MDdatacor “Splitting and Parsing” software. Reviewed thousands of text files while maintaining accuracy and efficiency under the HIPAA guidelines concerning personal medical information and the parsing of this information. Trained new Data Analysts in use of the MDdatacor proprietary software and analytical principles. Created training documentation for statistical sampling and analyzing clinical data. Researched clinical unstructured text and created rules for data validation to create scenarios for statistical reporting. Reviewed medical traits for data integrity and clinical accuracy. Extensive use of Access and Business Objects for customer reports and clinical trial rosters. Reviewed report output for data integrity and quality assurance. Assisted with development of the “MDdatacor Data Care Center” for the Health Insurance Industry payer community. Resume Laurie Maxwell Page 1 of 2
  • 2. SR. USER APPLICATIONS ANALYST II 02/01 to 06/04 Blue Cross Blue Shield of Georgia Atlanta, Georgia Ran extensive Cognos reports for claims data from the Electronic Data Warehouse (EDW) systems. Developed functional business requirements and translated them into system requirement specifications. Analyzed claims data for patterns and trends to formulate recommendations for process improvement and automation. Created user acceptance testing (UAT) scenarios for logic and benefit changes. Served as Project Lead and successfully implemented over 80 accounts onto the main frame system. Maintained all project documentation including project plans, issue logs and test scenario scripts. Developed financial processes documentation in accordance with the Sarbanes-Oxley federal mandate. Integral part of raising the Claims First Pass Rate from 63.41% to 71.94%. Assisted auditing department with mapping and identification of critical fields within EDW historical claims data. Automated a full benefit library for all accounts within the NASCO system. Administered security and maintenance of the online benefit inquiry and online help applications for the entire NASCO division of BCBSGA. PROJECT COORDINATOR 03/99 to 01/01 National Account Service Company (NASCO) Atlanta, Georgia Served as Implementation Project Lead for over 90 new accounts for the BC/BS Plans. Coordinated with Blue Cross and Blue Shield Plans across the nation on negotiating and implementing system changes. Created user acceptance testing (UAT) scenarios for all implementations. Completed user acceptance testing and maintained project issue logs and test scenario scripts. Worked extensively with Project Management Methodology (PMM) phases and documentation including problem analysis, business need, and cost and feasibility studies to determine the most effective solutions. Calculated Return on Investment (ROI) and documented full life cycle of small to medium projects. Served as liaison between the technical vendors (EDS and IBM) and the customer. NETWORK SERVICES REPRESENTATIVE 11/97 to 03/99 Medicare Secure Choice Atlanta, Georgia Managed a FoxPro database for over 2500 providers. Also, managed a Microsoft Access database for over 1000 out of area providers for possible expansion. Coordinated provider information for credentialing, marketing, enrollment, member services and administration. Administered all reports and tables for HCFA, HEDIS and NCQA guidelines and audits. Produced all reports for all business needs in the company. Reviewed report output for integrity of data. Developed, maintained and published the network provider directory. CUSTOMER SERVICE REPRESENTATIVE 03/94 to 11/97 Connecticut General Life Insurance Co. Atlanta, Georgia Handled in excess of 70 calls per day regarding the processing of HMO health claims. Educated members on all guidelines and protocols of managed care programs including Medicare and coordination of benefits. Extensive communications with members and providers. Creative problem solving regarding provider contract issues and electronic claims submission issues. Handled all appeals and grievances for the Florida healthplans. Training & Education Regulatory Compliance Security Training MDdatacor March 2006 to June 2016 Business Objects 6.5 “Intermediate Reporting” Business Objects SA July 2005 Diversity in Business WellPoint August 2003 HIPAA Policies & Security WellPoint June 2003 MS Project 98 ExecuTrain April 2000 Total Time Management Padgett Thompson AMA January 2000 Project Management Methodology NASCO November 1999 Dekalb Community College/Dekalb Technical School Certificate in Accounting Resume Laurie Maxwell Page 2 of 2