London Miller
joliet
Summary
Highly accomplished and results-driven healthcare professional with 13+ years of experience in provider/benefits configuration, business integration, data analysis, and quality assurance. Proven ability to lead teams, optimize processes, and deliver high-quality outcomes in complex healthcare environments. Expertise in SQL/SAS data analysis, automated testing, and project management. Adept at translating business requirements into technical solutions and driving process improvements.
Overview
9
9
years of professional experience
Work History
Sr. Tech Config Info Management Analyst
Molina Healthcare
04.2024 - Current
- Collaborates with Health Plans and Corporate teams to document end-to-end business requirements for critical configuration maintenance processes.
- Architects and designs comprehensive solutions aligning business and technical needs, leading projects from requirements to deployment.
- Write complex ad-hoc reports, designs templates, and automates configuration processes to improve efficiency and accuracy.
- Lead peer reviews, establishes standards, and guides technical and business resources through the software development lifecycle (SDLC).
- Manage complex projects, prioritizes tasks, triages issues, and ensures successful implementation.
- Evaluated existing systems and processes, identifying inefficiencies and recommending modifications for optimal performance.
- Evaluated current processes to develop improvement plans.
Quality Assurance Analyst II (Test Engineer)
Evolent Health
06.2021 - 02.2024
- Analyzed data sources and end-user requirements for healthcare data integration, focusing on eligibility, medical, pharmacy claims, and clinical data.
- Developed and executed SQL/SAS data quality test cases, managing documentation and defining standards to ensure data integrity.
- Automated test cases using Jenkins, performed regression testing, and presented test results, contributing to improved data quality.
- Mentored junior Test Engineers, contributing to continuous improvement of engineering and quality processes.
- Reported progress, test metrics and results to project stakeholders.
- Streamlined QA processes for increased efficiency and reduced time spent on redundant tasks.
- Acted as a liaison between the QA team and other departments such as Development, Customer Support, and Product Management, ensuring effective communication throughout all stages of the project lifecycle.
- Championed quality assurance initiatives within the organization by promoting a culture of continuous improvement and striving for excellence in all aspects of product development.
- Advised developers on problems with databases, performance and other issues.
Business Analyst
Evolent Health
06.2020 - 06.2021
- Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
- Improved business processes by analyzing current practices and recommending optimization strategies.
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
- Collaborated closely with stakeholders to identify opportunities for process improvements and drive continuous innovation in the organization.
- Supported software development projects by defining clear requirements and effectively communicating them to technical teams.
- Streamlined project management with effective communication and collaboration across cross-functional teams.
Business Integration Quality Analyst
Evolent Health
04.2019 - 06.2020
- Analyzed business requirements and supported testing for multiple projects, ensuring compliance with HIPAA regulations.
- Documented and evaluated test results and defects, tracking issues and collaborating with development and business teams for resolution.
- Partnered with Business Analysts, Project Managers, and Client Delivery Managers to ensure thorough documentation, understanding, and testing of requirements.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Advised developers on problems with databases, performance and other issues.
- Collaborated with cross-functional teams to develop and implement targeted solutions for identified quality issues, ensuring continuous improvement.
- Identified process inefficiencies through meticulous data analysis, leading to streamlined operations and increased productivity.
- Led root cause analysis initiatives that resulted in significant reduction in recurring defects.
Provider Configuration Supervisor
Evolent Health
02.2018 - 04.2019
- Managed a team of configuration specialists, disseminating work assignments, assessing training progress, and ensuring adherence to best practices.
- Served as Subject Matter Expert (SME), training new team members and representing the team in client meetings.
- Documented potential system enhancements, identified performance improvement areas, and supported system upgrades.
- Mentored junior staff members in their career development, sharing knowledge from years of experience in the field.
- Developed staff skills through targeted training programs, resulting in improved performance and career growth opportunities.
- Enhanced team productivity by streamlining workflow processes and implementing efficient scheduling systems.
- Reduced conflict incidents significantly, fostering cohesive team environment through effective conflict resolution strategies.
- Enhanced operational workflow, identifying and eliminating bottlenecks in daily procedures.
- Oversaw compliance with industry regulations and company policies, ensuring safe and legal operational environment.
- Conducted thorough employee evaluations to identify areas for growth and development, leading to more skilled workforce.
Provider Configuration Analyst
Evolent Health
09.2016 - 02.2018
- Maintained provider data within the claims processing system, managing credentialing variables, demographics, contract assignments, and network affiliations.
- Troubleshot claims suspended in work queues, collaborated with IT to improve auto-adjudication, and documented necessary rework.
- Contributed to team knowledge by training new members, sharing information, and documenting policies and procedures.
- Provided timely support for end-users, resolving configuration-related issues quickly and effectively.
- Conducted root cause analyses of configuration issues, identifying areas for improvement and implementing corrective actions accordingly.
- Established clear communication channels between stakeholders to ensure smooth execution of changes in system configurations.
- Reduced errors in software releases by implementing rigorous change control procedures.
- Troubleshot incidents reported by end-users to schedule system changes and identify permanent solutions.
- Analyzed existing systems and databases and recommended enhancements to solve business needs
- Maintained high levels of data accuracy within the CMDB by regularly updating records and performing quality checks.
- Ensured compliance with company standards by conducting thorough configuration audits.
Benefit Configuration Analyst
Evolent Health
01.2016 - 09.2016
- Created and maintained group/benefit configurations, managed access to the claims processing system, and implemented system upgrades.
- Supported claims processing by handling recalculations, troubleshooting configuration-related issues, and participating in error corrections.
- Implemented change control, configuration status and configuration audits.
- Maintained high levels of data accuracy within the CMDB by regularly updating records and performing quality checks.
- Assisted in the implementation of new systems, ensuring seamless integration with existing infrastructure through careful configuration planning.
- Developed comprehensive documentation for all configuration processes, facilitating knowledge sharing among team members.
- Ensured compliance with company standards by conducting thorough configuration audits.
Education
No Degree - Medical Billing And Coding
Coyne College
Chicago, IL06-2010
Bachelor of Science - Sociology
Chicago State University
Chicago, IL01-2004
Skills
- Healthcare Expertise: Provider Configuration, Benefits Configuration, Claims Processing, Medicaid, Medicare, CMS, HIPAA Compliance
- Data Analysis & Reporting: SQL, SAS, Data Warehousing, Data Quality, Requirements Gathering, Report Development
- Process mapping
- Quality Assurance: Test Case Development, Test Execution, Defect Management, Regression Testing, Automated Testing (Jenkins), TestRail
- Business Analysis: Requirements Gathering, Process Analysis, Workflow Optimization, Documentation
- Project Management: SDLC, Project Planning, Issue Triage, Team Leadership, Stakeholder Communication
- Software & Tools: Selenium, PostMan, Jenkins, Agile, JIRA, Microsoft Office Suite (Excel, PowerPoint, Visio)
- Medical Coding: ICD-9/10, CPT, HCPCS, Medical Billing Processes
- Active listening
- Effective communication
- Adaptability and flexibility
- Task prioritization
Timeline
Sr. Tech Config Info Management Analyst
Molina Healthcare
04.2024 - Current
Quality Assurance Analyst II (Test Engineer)
Evolent Health
06.2021 - 02.2024
Business Analyst
Evolent Health
06.2020 - 06.2021
Business Integration Quality Analyst
Evolent Health
04.2019 - 06.2020
Provider Configuration Supervisor
Evolent Health
02.2018 - 04.2019
Provider Configuration Analyst
Evolent Health
09.2016 - 02.2018
Benefit Configuration Analyst
Evolent Health
01.2016 - 09.2016
No Degree - Medical Billing And Coding
Coyne College
Bachelor of Science - Sociology
Chicago State University
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