CHAKA BELL Houston, TX. 77598ChakaBell@yahoo.com

(770)712-1717

SUMMARY OF QUALIFICATIONS:

Analytical and results driven consultant possessing 10+ years of experience in claim systems and peripheral clinical applications implementations with an emphasis in compliance and clinical reporting. Resourced out as a project manager and analyst supporting business process outsourcing operational engagements including but not limited to system; configuration, calibration and redesign.

KNOWLEDGE AREAS OF EXPERTISE:

Configuration and Processes– Claims - Batch, Adjudication and Adjustment– Membership - Enrollment and Customer Service– Provider - Contracting, Pricing and Maintenance– Medical Mgt - Auths, Discharge Planning, Case Mgt

NCQA HEDIS Reporting– Commercial– Medicare– Medicaid

AHCA FL State Medicaid Reporting

Requirements Documentation– Business– Technical– Functional – User Cases

Project Management- PMP Methodology

Analyst- Business- Data/Reporting

CLIENT ROSTER ROLE AND TENURE:

BlueCross BlueShield of MI, Business Systems Advisor, 12 months Kaiser Permanente of COHI, Business Analyst, 12 months UnitedHealth Group PCP, Data Business Analyst, 12 months UnitedHealth Group NHP, Business Analyst, 24 months UnitedHealth Group NHP, Project Manager, 48 months HarvardPilgrim HealthCare, Project Manager, 12 months Kaiser Permanente of M-A, BPO Operations Manager, 36 months Anthem BlueCross BlueShield, Business Analyst, 12 months

PROFESSIONAL EXPERIENCE:

RGIS Logistic Services – Houston, TX. 11/2014 - PresentAuditor Effectively audit wholesale and retail pharmacies that encompasses the following product types; practitioner

prescriptions, over the counter medications, medical device products and soft line sales. Oversee key pharmacy chain accounts by recommending approaches to improve inventory control processes with an emphasis on loss prevention and product shrinkage.

Dell Healthcare and Life Science - Miami, FL. 03/1995 – 03/2014 Business Systems AdvisorHealth Effectiveness Data Information System Compliance Reporting Project Served as the Healthcare Effectiveness Data and Information Set (HEDIS) technical lead and oversaw database

repository functions that integrated members, providers, medical/facility claims, pharmacy services, capitated encounter records, lab claims/values, pseudo claims, and Medical Records Review (MMR) data into certified software applications. Authored HEDIS Roadmap audit document requests that surrounded data completeness checks, data integrity tests, database table structures, data flowcharts and nonstandard codes crosswalk tables. As a result, The National Committee for Quality Assurance (NCQA) has awarded the team’s performance with a commendable accreditation status in all quality care performance measures annually.

AMISYS Commercial, Medicare Advantage and Medicaid System Upgrade Project Lead a claims system upgrade comprised of peripheral applications such a web product, data warehouse, FTP

inbound and outbound processes/interfaces of membership, claims and providers. Managed a conversion project that encompassed 100’s of AMISYS, MS Access and MS Excel operational reports into Crystal Enterprise concurrently. Funneled specifications to offshore team of developers that converted each report’s programming code into SQL stored procedures. Worked with business owners and solidified conversion reports criteria also tested and promoted reports to production. As a result, all reports were located in one repository and many reports were streamlined and/or determined redundant.

Facets Commercial System Migration Project Worked as a technical lead on an AMISYS to Facets migration two year project. Created an extensive amount of

business requirements documents that surrounded interface and transmission files between the client, employer groups and external delegate vendors such as; pharmacy, lab, therapy, psych and vision. Developed technical requirements documentation mapping data of all inbound/outbound files from the legacy system into the latest format that supported the new technology. As a result, the interfaces and transmissions of files between employer groups and vendors met all requirements and went live as scheduled.

AMISYS Medicare Advantage System Migration Project Executed a Medicare Advantage Migration Project as a business analyst and migrated data from a legacy system

into a newly tailored application platform. Performed business requirements assessment functions via interviews with senior leaders and SME’s then documented departmental processes for system setup. Configured multiple modules including but not limited to; claims (medical, facility), medical management (referrals, case management), providers and pricing (fee schedules, PCP, specialty, hospital) contracts. As a result, the position evolved into an operations manager role that supported daily interfaces, payables and system calibration.

Xcelys Claims Application Upgrade Project Performed as a data analyst and executed SQL queries against several system version environments and

determined table layout changes and impacts of data and system processes. Developed analysis documents that captured version schema variances from a database table, column and/or field size perspective. Oversaw share-point site of analysis documentation for version control and repository purposes. As a result, the project team was able to trim several weeks of system upgrade time by migrating vs. upgrading large volume data fields not requiring conversion schema changes.

UnitedHealth Group – Miami, FL. 03/2011– 05/2012Data Business AnalystHealth Effectiveness Data Information System Compliance Reporting Project Served as the HEDIS technical lead for both Medicaid and Medicare lines of business data collection deliverables.

Identified, analyzed and created approaches to address transactional and non-transactional integrity and completeness data anomalies. Supported on-site HEDIS audit and produced SQL ad-hoc reports of operational and statistical information that benchmarked specific Medicare and Medicaid utilization measures. Developed a tool that monitors, evaluates, and disseminates correspondence to physicians and their insurers to seek preventable care. As a result, these actions created a template for ongoing predictive modeling initiatives.

The Agency for Health Care Administration Florida Medicaid Health Plan Report Project Functioned as a data analyst and oversaw The Agency for Health Care Administration (AHCA) Medicaid Health Plan

Report Guide Project. Ensured the health plans interpretation of report measures for members, providers, claims, data templates and attestations were submitted according to contract language. Worked cohesively with multiple delegate provider-types such as; dental, pharmacy and behavioral health to ensure their catalog of AHCA report submissions were delivered truthfully and timely. As a result, this effort introduced fraud and abuse detectors, prevented non-compliant sanctions and increased the health plans Medicaid membership of enrollees.

SYSTEMS AND APPLICATIONS EXPERTISE:

Dell Xcelys DST AMISYS ikaSystems Claims TriZetto Facets SQL MS Office Suite

MS Project MS SQL Enterprise Manager MS Visio Inovalon QSI HEDIS Suite McKesson CRMS HEDIS Suite Verisk HEDIS Suite

Apogee Provider Credentialing Captiva Claims Document Mgt Crystal Enterprise LabCorp Datalink Optum MS-DRG Grouper, Pricer

EDUCATION AND CERTIFICATIONS:

Bachelors Business Administration - Columbus University License Life and Health Insurance – Texas Dept of Insurance Certification Emergency Medical Technician Paramedic - Houston College Certification PM100 Successful Project Management