Health Plan Solutions Engineer II – Claims, Encounters & Quick Claims - Availity - Remote
(2024-01 - 2026-12)
Subject Matter Expert (SME) for Availity Portal 837 X12 Claims and Encounters and Quick Claims Health Plan onboarding
- Gathered Health Plan Business and IT requirements to onboard new and existing Health Plans onto the Availity Portal
- Partnered with Sales Team (pre- and post-sales), Project Managers, and Implementation Analysts to ensure timely deployment against Health Plan deliverable dates
- Collaborated on Functional End-to-End Testing and Health Plan User Acceptance Testing (UAT); provided post-QA and PROD deployment support
- Authored and maintained Health Plan Confluence pages reflecting build status and settings for production deployment
- Presented Claims and Encounters Business and Architectural Overviews internally and externally to prospective and contracted Health Plans
- Wrote End-to-End test case scenarios for Functional and UAT testing
- Expert user of Salesforce, Jira, Confluence, and Atlassian Platform (Kanban); transitioned fully to new Atlassian Platform in April 2026
- Daily adoption of Microsoft Copilot AI for email drafting, presentation analysis, and PowerPoint creation/maintenance
- Utilized Kiro AI to efficiently generate Jira tickets from templates, eliminating manual one-by-one ticket creation
IT Delivery Management Oversight – Solution Consultant - Kaiser Permanente National - Remote
(2016-01 - 2024-12)
IT R2 Business Liaison and application-layer SME for 3M 360 Computer Assisted Coding (CAC), CDIS, and WebCRS for NW and SCAL regions
- National EPIC IT Project Manager for Member Payment Solution and Credit Balance Processing and Prevention investment projects; managed budgets, LOEs, resource allocation, and stakeholder reporting
- Led cross-functional meetings, action items, and deliverables for CAC EPIC New Facility initiative while adhering to EPIC project timelines
- Managed Remedy Work Orders and Charge Requests with high accountability to business owners; maintained SOX/HIPAA compliance
- Led Jira deployment within Kaiser, including user management; deployed Confluence successfully
- Accountable for ATLAS (asset tracking) and Fusion (Disaster Recovery) system-of-record completeness
- Supported Revenue Capture applications: Claims Manager (Optum), ePREMIS (Optum/Change Health Care), and 3M 360 Encompass (3M)
- Developed and presented strategic 5-year roadmaps aligned with customer requirements and leadership expectations
Project Manager / Claims Manager Application Coordinator – KP IT Solution Consultant - Kaiser Permanente - Remote
(2006-01 - 2016-12)
Project Manager and Application Coordinator for ClaimsManager (ICD-9-CM and CPT charge scrubber for EPIC Resolute Professional Billing) across all Kaiser regions
- Managed deployment, support, and Ingenix build for six regions; conducted weekly status calls and extracted Claims Manager reports per business partner requirements
- Maintained 20 ClaimsManager databases current with NCD/LCD updates monthly and CCI Knowledgebases quarterly
- Translated business and coding requirements into configuration changes; performed regression, end-to-end, enhancement, and service-package testing
- Served as cross-regional SME for ClaimsManager; coordinated cross-functional groups for regional initiatives
- Engaged SOX team to write narratives applicable to ClaimsManager; followed Release Management and Change Control processes
- Traveled within the U.S. for deployment, support, and client training
Senior Consultant / National Claims Manager Application Coordinator - Covanxys - Pasadena, CA
(2005-01 - 2006-12)
Claims Manager Application Coordinator for Kaiser Permanente Regions Outside California (ROC's)
- Managed deployment, support, and Ingenix build for six regions; maintained 16 databases with monthly NCD/LCD and quarterly CCI updates
- Conducted weekly status calls and delivered reports based on business partner requirements
- Traveled nationally for client deployment, support, and ClaimsManager training
- Followed Kaiser Release Management and Change Control processes
Claims Manager Implementation Project Manager - Optum / Ingenix - West Valley City, Utah
(2001-01 - 2005-12)
Implementation Project Manager and Training Consultant for Kaiser Permanente nationally for ClaimsManager (ICD-9-CM and CPT scrubbing application)
- Led end-to-end project delivery from initiation through post-on-site training for a large national client base
- Conducted weekly status calls, data verification, and system management across multiple regions
- Traveled nationally for client training, support, and troubleshooting
- Applied coding expertise to ensure clean claims submission for proper reimbursement
Professional Coder and Billing Expert - University of Utah Health Network - Layton, Utah
(2000-01 - 2001-12)
- Performed daily batching and coding for nine-provider encounters
- Oversaw correct data entry into IDX TES BAR Practice Management System for proper reimbursement
- Provided provider education on real-time coding and monitored billing/coding trends
- Implemented compliance policies and procedures; worked Edit reports and adjusted coding for clean claim submission
Compliance Officer and Coding Expert - Country Hills Eye Center - Ogden, Utah
(1999-01 - 2000-12)
- Coordinated correct use of CPT, ICD-9-CM, and HCPC codes for proper reimbursement
- Audited Medicare charts using a documentation tool to verify correct Evaluation and Management codes
- Reported chart audit results to physicians, staff, and administration; conducted ongoing compliance education
- Managed the Charge Master, collections, and audit charts; reported revenue impact of improper claim submission
Professional Coder and Insurance Specialist - Wade D. Martineau, D.M.D., M.D. - Ogden, Utah
(1998-01 - 1999-12)
- Applied ICD-9-CM, CPT, and HCPC codes to medical documentation for insurance submission
- Coordinated patient benefits and reimbursement with Medicare, Medicaid, Workers Compensation, and commercial carriers
- Coordinated surgical prior authorizations; registered patients, processed EOBs, and managed delinquent accounts
Professional Billing Coordinator - Talbert Medical Group - Ogden, Utah
(1997-01 - 1998-12)
- Assigned ICD-9-CM, CPT, and HCPC codes according to medical documentation; educated staff on proper documentation and claim submission
- Performed follow-up on outstanding balances; managed front office duties including patient registration, eligibility verification, and scheduling
- Conducted audits of missing information, delinquent accounts, and private-pay reports
Medical Records and EHR Implementation Specialist - Healthcare Organization
(1991-01 - 1997-12)
- Managed release of medical information to attorneys, insurance carriers, other providers, and patients
- Participated in the implementation of EpicCare Ambulatory computerized patient medical records system; served as a pilot site for EpicCare
- Inputted records via scanning and data entry into ERM EpicCare Ambulatory; sat on committee to assess system functionality
