rebecca a lee

Rebecca A Lee367 State Street Albany, NY 12210

Phone: 518-434-3455 E-mail: [email protected]

ExperienceConfiguration Supervisor (2013 – present)CDPHP

Supervisor of Pricing Configuration with 7 direct reports Participant and lead Pricing Analyst in various high level corporate projects Lead for Coordination and Training of configuration pricing resources Work with Configuration and Business Partners to prioritize and implement

changes Develop training tools and documentation Document various CMS and NYS pricing changes for internal and external

staff Various reporting & analysis to support management & CDPHP initiatives Support and Assist management as needed Configuration lead on the Medical Injectable project Implement process improvements i.e. Peer tasks to reduce defects,

visually walking through defects in the system with staff to show where the breakdown happened

Work with team members on best practice for new configuration Work with Quality, Architect & Developers to create and enhance reports

to reduce defects

Configuration Analyst/Team Lead (2005 – 2013)CDPHP

Pricing configuration, configure practitioner, facility, ancillary and capitation contracts

Team member of the System Conversion Project from Amisys to Facets (BTI)

Team member on the EPC implementation project Team member on the Modeler Application implementation Team Member on the ICD10 project Work with EAS to implement various capitation arrangements i.e. Capital

Cardiology and Dr. Kogan Facets Patching team member responsible for evaluating and testing

releases Facets upgrades for 4.81, 5.10 Optum New Rate Manager implementation (CDPHP was the pilot for this

Resume: Rebecca A Lee

new product) Transition from Ingenix UCR data to FAIR Health Team participant on various new products to ensure pricing requirements

are identified and implemented. Team member for St. Peter’s Health Partners changes Configuration lead on NetworX Automation project Responsible for Optum PPS patches, updates and maintenance as well as

web services upgrades. Worked with technical services for process improvements and

documentation of Optum processes to reduce possible defects and ensure successful updates. Received training from technical services to apply updates directly to the server for all Optum updates as a failsafe if a technical services resource is not available

Responsible for working with technical services on resolving issues related to NetworX

Work with Trizetto and Optum on product improvements and defects Resource for pricing team to assist and resolve issues Acted as a liaison between IT (technical services) and configuration IBM robot adjustment performance Participant as a super user for all IT upgrades Attend meetings as needed Work on Corporate initiatives, attend meetings, create solution

documents, represent configuration

Configuration Testing Coordinator (2004 – 2007)CDPHP

Create test beds for claims adjudication scenarios Test day to day configuration changes Test benefit configuration i.e. Changes made to base contracts and riders

for various products and lines of business Test pricing configuration changes i.e. Changes made to hospital,

practitioner and ancillary provider contracts Test and assist in the implementation of new applications, products, and

new releases of Amisys Work on corporate initiatives, attending meetings representing the model

office as required

MCR Specialist II (2002 – 2004))CDPHP

Provided technical support to MCR staff and Management, as well as other departments within the company

Reviewed and provided revisions to MCR department procedures Trained MCR staff members Assisted with testing of various projects as required Adjudicated secure (employee) claims and adjustments Provided Resolution to inquiries from internal departments such as

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member services and provider services

MCR Claims Specialist II (2001 – 2002)CDPHP

Reviewed the quality of work performed by MCR specialists and COB specialists

Ensured consistent quality measures and guidelines were adhered to

MCR Quality Analyst (1999 – 2000)CDPHP

Responsible for adjudicating health insurance claims according to processing guidelines

Reviewed claims reports for accuracy Utilized member and provider contracts, as well as medical policy and

procedures Consistently met quality standards and quality expectations

Claims Examiner (1998 – 1999)Kaiser Permanente

Responsible for adjudicating health insurance claims according to processing guidelines

Reviewed claims reports for accuracy Consistently met quality standards and quality expectations

Skills Prospective payment system Facets NetworX Core Facets Pricing Capitation Excel Toad Word Visio Power Point Access Cognos

EducationHudson Valley Community College

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rebecca a lee

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