Chaka Bell is an analytical and results-driven consultant with over 10 years of experience in claims systems and clinical applications implementations, with a focus on compliance and clinical reporting. She has experience as a project manager, business analyst, and operations manager supporting various health insurance clients. Her expertise includes configuration of claims, membership, provider, and medical management systems, as well as NCQA HEDIS and AHCA Florida Medicaid reporting.

1. CHAKA BELL
Houston, TX. 77598
ChakaBell@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 - Present
Auditor
 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 Advisor
Health 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

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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– 05/2012
Data Business Analyst
Health 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