Janice C. Young
- Business Analyst II
- Woodland Hills, CA
- Member Since Mar 18, 2023
Candidates About
Janice C. Young
Employment History
Centene (formerly HealthNet of California)
21281 Burbank Boulevard
Woodland Hills, CA 91367-6607
Centene bought Health Net, Inc. July 2, 2015.
April 30, 2016 to present
Business Analyst II
October 25, 2010 to April 29, 2016
Title: Business Systems Tester
2018: Project management switched from Waterfall project management to Agile project management. Trained on Agile, JIRA, and SQL.
Test Lead for 3 Projects (tasks outside scope of position)
-PID 12803-14871 - Arizona Migration Regression –7/31/2012 to 11/6/2012 - computer systems change for Arizona product line; test lead for regression testing portion, wrote script for project, and oversaw tester staff, point of contact for issues and progression of project
-PID 18549 AZ Outpatient Facility to iHealth – July 10, 2014-September 17, 2014 – was assigned as project test lead to take over from a Senior Business Analyst out on medical leave –vendor pricing application project
-PID 20256 –-CASL Redesign – March 14-April 5, 2016 -Assigned as project test leadto take over from a Cognizant Business Analyst Test Lead who was not following through on the project - project was an upgrade on system logic for updating product plan codes and subsequent benefits and copayments/coinsurance
-The Business Systems Tester performs functional and end-to-end testing for all projects that effect healthcare operations business systems. This individual will play a key role in all testing activities that support and ensure all project s are built and working correctly prior to their implementation into production.
-Executes script scenarios to test files and software that are utilized to support business production. Performs end user testing for new programming enhancements, new benefit designs, new provider contacts, software changes or any change to the existing ABS and MC400 systems, along with other related systems as necessary.
-Proactively identifies opportunities and recommends system solutions that increase automation, resolve system deficiencies and enhance business processing to meet and exceed business requirements.
-Develops and maintains effective business relationships with project team and internal and customers.
-Ensures compliance with government regulations and requirements (NCQA, DOC, HCFA).
-Reports the root causes and facilitates corrective actions as needed.
-Maintains and updates knowledge of all appropriate products, contracts and standard reference materials.
-Develops and maintains a comprehensive knowledge of the impacted healthcare business systems area, including but not limited to ABS, MC400 and QCare, Membership, Unity, etc.
-Performs other duties and projects as assigned.
-Third and fourth quarter 2012: assisted with in-house computer migration, moving Health Net of Arizona into Health Net of California, Inc., from MC400 into ABS. Responsible for regression testing current RMC codes, which included writing, data prepping, and processing the script, gathering resources, ensuring environment was complete, and reporting and retesting defects.
-Fourth quarter 2014: assigned as project lead for project testing for adding and implementing a program to send AZ outpatient claims for iHealth pricing
January 31, 2005 to October 22, 2010
Title: Claims Examiner
-new day claims processor
-process HMO, Performance Groups, Medicare Advantage, and Flexnet claims
-generate and close ISFs as relates to claims issues
-researched, did monetary conversions for, and processed all foreign claims
-work overtime when required and needed
-assist with overpayment and recovery projects when offered
-requested by Provider Dispute Resolution supervisor and manager to provide temporary assistance in Provider Appeals
-transferred to Medicare Advantage Unit April 2010
-assisted with Attorney General Audit September 21-22, 2010
Meridian Health Care Management
6200 Canoga Avenue
Woodland Hills, CA 91367
(818) 673-1900
March 22, 2004 to January 5, 2005
Title: Lead Pricing Coordinator
-maintain provider pricing database tables based upon contract information and client guidelines to ensure claims are processed accurately
-interpret, analyze and identify provider contracts to determine required pricing configuration rules
-act as liaison in researching, resolving and documenting complex claims and customer service issues related to pricing
-monitor and track all general and pricing database reference table updates
-reports and requests system modifications and enhancements to increase claims batch adjudication and productivity
-interact with Client Relations to obtain and/or clarify provider reimbursement rates and other provider information to ensure database integrity
-learned and assisted when needed on benefits renewals and adding new benefit packages
-assisted with claim adjustments
-work overtime when requested and needed
-low absenteeism
HealthNet of California
21281 Burbank Boulevard
Woodland Hills, CA 91367-6607
(818) 676-6077
September 22, 2003- March 19, 2004
Title: Claims Adjuster
-medical insurance claims adjuster
-adjust HMO, PPO/POS, and OOA/OON claims
-adjustment requests may entail: incorrect processing, eligibility change, provider contract change, authorization updates, tier changes, timely filing exceptions
-adjustments include both member and provider requests
Meridian Health Care Management
6200 Canoga Avenue
Woodland Hills, CA 91367
(818) 673-1900 (initially a CSRG assignment, then hired full time late
November 2002)
July 15, 2002 to September 19, 2003
Title: Senior Claims Examiner
-claims processor for PacifiCare Washington, PacifiCare Oregon, and
Kaiser-Permanente/Colorado Springs plans
-AS400 system
-provider customer service specialist
-identified benefit, co-payment, and contract issues
-key Claim Analyst on system upgrade/worked with Director of Claims
-special contact/processor for Extendicare SNF facilities
-perfect attendance
-worked overtime when both requested and required
CIGNA Group Insurance
Gateway View Plaza
1600 West Carson Street, Suite 300
Pittsburgh, PA 15219
(412) 281-1547 (Insurance Overload assignment)
April 15, 2002 to May 31, 2002
Title: Customer Service Representative
-temporary, full-time position
-life insurance and accidental death and dismemberment policies
-relay status of claim and/or payment information
-respond to general information service queries
-assist in routing incorrect calls to other CIGNA divisions
-assist policyholder human resource departments and beneficiaries in
reviewing claim form and advising on the submission process
-generate "Compliance Acknowledgment" and Form 712 system letters
Highmark Services/Blue Cross-Blue Shield
501 Penn Avenue
Pittsburgh, PA 15222
(412) 281-1547 (Insurance Overload assignment)
October 19, 2001 to February 8, 2002
Title: Claims Examiner
-temporary, full-time position
-processed electronic rollover Medicare claims
-carve-out plan
-calculated and applied out-of-pocket manually
UPMC Health Plan
One Chatham Center
Pittsburgh, PA 15219
(412) 454-7845
July 1, 2000 to October 3, 2001
Title: Team Leader/Auditor
-unit quality auditor
-trained new hires on Medicaid claims processing and contracts
-researched and wrote Medicaid policy and procedure
-generated system changes in accordance with Department of Public Welfare
contracts and guidelines and Pennsylvania State law
-ongoing system review of compliance with Medicaid contracts
-company wide contact representative for Medicaid issues
-identified incorrect loading of providers and fee schedules
-reviewed and tested contracts for correct DRG payment
-assisted Provider Representatives both on- and offsite on Medicaid
compliance
-contact representative for external provider Medicaid billing issues
-pended claim analyst for all departments and recommended system revisions
-assisted Pricing Department on Medicaid fee schedules and reviewed system
enhancements
-chaired weekly interdepartmental pended claims meetings to identify system errors and to brainstorm resolutions
September 20, 1999 to June 30, 2000
Title: Claims Examiner
-processed claims for both Commercial and Medicaid products
-low error ratio in claims processing
-thorough understanding of written plan documents and benefits
-processed Commercial and Medicaid claims as primary
-processed Medicaid claims as secondary or tertiary
-resource for questions concerning both Commercial and Medicaid issues
-successfully completed adjustment training
-performed quality reviews on Commercial plan
Special Projects/Accomplishments
-received "Best Quality - Medicaid Unit" October 12, 2000
-created "Claim Processing Tips and General Guidelines" quick reference for Commercial product
-attended and actively participated in Team Building/Time Management
seminars
-assisted in development testing on AMISYS for Medicaid conversion February 24 and 25, 2000
-assisted with phone overflow for Commercial Customer Service
-assisted with offsite UB-92 Biller Training September 22, 2000
-assisted with offsite HCFA -1500 Biller Training October 10, 2000
-low absenteeism
-a willingness to work in a team environment and to promote company ideals and models
-worked overtime consistently
Kirkpatrick and Lockhart LLP
1500 Oliver Building, 14th Floor
Pittsburgh, PA 15222-2312
(412) 355-6727
April 29, 1999 to May 28, 1999
Title: Proofreader
-temporary, full-time position
-proofread legal contracts and documents
-materials proofread: wills, deeds, contracts, annual reports, patents,
instruction manuals, matter against Dictaphone tapes
-edited company newsletters
Pittsburgh Clinical Research Network (PCRN)
UPMC Montifiore, Kaufmann Building
3471 Fifth Avenue, Suite 202
Pittsburgh, PA 15213
(412) 692-4444
February 9, 1999 to April 8, 1999
Title: Medical/Technical Editor
-temporary, part-time position
-reviewed drug company protocol requests for human studies to edit down to a brief summary for submission to the Internal Review Board for approval
-created a standardized database of physician profiles utilizing curriculum vitae for use in protocol studies
-created consent forms for human studies
-edited clinical journal submissions for publication
Lee Shore Literary Agency
440 Friday Road
Pittsburgh, PA 15209
(412) 821-0440
August 1997 to present
Title: Freelance reader/editor
-read manuscripts to recommend for resubmission, edit, and/or contract
-utilized and followed guidelines and editing principles of the Chicago
Manual of Style
-edited manuscripts, provided written analyses, and verbal communication upon request
-proofread and edited galleys for publishing
-reviewed screenplay submissions for subject viability and timeliness
United Health Care (formerly MetLife)
USX Tower - 600 Grant Street
Pittsburgh, PA 15219
(412) 355-3550
July 23, 1990 to October 22, 1998
Title: Claims Service Specialist
-processed United Health Care claims as primary
-processed as secondary to Blue Cross/Blue Shield, Medicare parts A and B, HMO, indemnity plans, and processed both Medicaid and Medicare
reimbursements
-knowledge and application of both CPT-4 and ICDM-9 coding and DSM manuals
-understand and apply indemnity and HMO/PPO plans and contract write-offs
-low error ratio in claims processing
-high quality and quantity in claims production. Average: 800-1000 claims weekly
-resolved both inter-unit and outside office overpayments
-thorough understanding of plan documents and benefits
-processed Employee Spending Account claims
Title: Customer Service Specialist
-claim and benefit queries resolved via telephone and correspondence
-monthly telephone contact with customer Human Resource Representatives for quality and problem resolution
-attended monthly conference calls with corporate customer (Philips
Electronics)
-excellent telephone and interactive skills
Special Projects/Accomplishments
-Defect Reduction Representative for both unit and office
-created training packet for unit claims processing
-trained fellow team-members on Employee Spending Account claims
-elected by unit to be sick time/call-off coordinator due to low absenteeism
-volunteered and learned other unit and other office claims
-unit representative at policyholder office meetings
-due to skill mapping, customer (Philip Electronics) initiated my proposal for electronic Employee Spending Account rollovers, a time- and money-savings factor
-volunteered, was trained in, and trained others on ProAmerica, a pricing contract
-volunteered and was nominated by managers to be an Office Advocate, and taught classes in interpersonal and leadership skills
-created tip sheet to calculate daily backlog and production requirements
-quality representative for unit
-attended daily meetings with managers to balance staff and work load
-assisted in reviewing accuracy of plan benefit information for computer conversion target date of January 1, 1999; liaison for customer client administrator and staff
-selected by office manager to participate in automated letter study October 13 to 24, 1997
-low absenteeism
-willingness to work overtime when needed
Presbyterian-University Hospital
200 Lothrop Street
Pittsburgh, PA 15213
(412) 647-5555
October 1989 to March 1990
Title: Medical Data Processor
-part-time weekend work entering laboratory requisitions into a computer to reroute to the central laboratory for processing
-relayed laboratory results to physicians and nurses via telephone
-light filing
Allergy and Clinical Immunology Associates
The Tower - 180 Fort Couch Road
Pittsburgh, PA 15241
(412) 833-8811
May 1980 to September 1989
Title: Medical Receptionist/Biller
-patient interaction
-appointment scheduling
-telephone coverage
-claims submittal to Blue Shield, Medicare part B/65 special, Medicaid,
HMOs/PPOs, and indemnity plans
-knowledge and application of CPT-4 and ICDM-9 coding
Education
University of Pittsburgh 1986 to 1999
Major: Film Analysis Dean's List every semester
Minor: Criminal Justice/Psychology
Pierce College
Microsoft Excel Class Spring 2004 Grade: A
Microsoft Access Class Fall 2007 Grade: B