1. LISA M. LONGFELLOW
118 Third Avenue • Pittsburgh, PA 15229 • 412-931-0214 • Lisa.Longfellow@iCloud.com
http://www.linkedin.com/in/lisalongfellow/
HEALTH INSURANCE| BUSINESS ANALYTICS | RECOVERY OPERATIONS |TRAINING | QUALITY
I am an innovative thinker with a solid, well-rounded knowledge base of the health insurance field.
Professional Experience:
UPMC Health Plan, Pittsburgh, PA 07/2014 TO
PRESENT
Configuration Analyst, Associate
• Responsible for daily Microsoft Access queries to update the Test and Production environments.
• Responsible for recurring reports for the Provider Configuration Department and management.
• Perform analysis and troubleshoot Microsoft Access Queries and Macros.
• Use Geo Networks Geo Report software for access reports, disruption reports and spherical
access range analysis.
• Responsible for creating and maintaining departmental process and procedure documentation.
• Team liaison for outside Vendors.
• Independent ad-hoc analysis of the Provider Information data.
• Review current process and procedures for process improvement and efficiency analysis.
Celerity IT LLC, Pittsburgh, PA 01/ 2013 to
08/2013
Senior Business Analyst
Performed business analysis to determine requirements for an internal document factory and wrote requirements for
presentation in a Vision Statement, Use Case and User Interface Document.
 Wrote, tracked and tested the project’s requirements using the Rational Unified Process (RUP).
 Reviewed XML files for system test and accurate placement of tag information.
 Created a mock-up using the InDesign tool that allowed the business to envision the final product.
PNC, Pittsburgh, PA 2010 to 2013
Senior Quality Business Analyst Healthcare Operations
Worked on 27X Electronic Data Interchange companion guides and assisted in creating business rules using IBM’s
ILOG software.
 Built and tested 837 Electronic Remit Rules using IBM’s ILog BRMS application. Worked toward a
successful team goal to have all companion guides built and tested before November 1, 2012.
 Performed quality review on business rules against payer/provider CMS bulletins. All rules were built and
tested, by our team, before management’s proposed completion date.
 Created Companion Guides for 270 Eligibility Request and 276 Claim Status using Edifecs 6.8 application.
 Created process documents for: ILOG’s business rules, Rule Studio and Access Update Query.
 Utilized Oracle Business Intelligence Impromptu to create monthly reports for management.
 Created a daily 837 Transaction Report: Validated information and updated Access database.
 Received Veteran’s Administration Clearance to view classified and protected health information.
 Member of the PNC Employee Satisfaction Group and PNC Grow-Up Great Volunteer.
United Healthcare (Unison), Pittsburgh, PA 2009 to 2010
Application Business Analyst
Performed IT support for the Facets Claim Application’s Public Sector-Medicare, Medicaid Product.
 Analyzed Provider contracts for entry into the claim application.
 Conducted root-cause analysis of claim process errors and performed system configuration adjustments,
when necessary, to correct the errors.
 Utilized the HPSD Service Desk, Mercury Quality Center (Test Director) and Harvest Implementation
Package Network for change and break-fix project work.

2. Lisa M. Longfellow
Resume, Page 2
Professional Experience: Continued
Coventry Health Care, Cranberry Twp., PA 1996 to 2008
Business Analyst and Recovery Supervisor
Conducted root-cause analysis of medical, dental and pharmacy claim overpayments including Worker’s
Compensation and third party liability. Pulled daily reports and assisted with team motivation and processing to meet
production goals.
 Performed business analysis for system enhancement.
 Worked with programmers to test code changes.
 Assisted with the recovery of approximately $74 million in claim overpayments for the year 2008.
 Conducted procedural analysis for process control and improvement; including documentation and training.
 Constructed idea to reduce 75% of manual work when funds were returned to customers. Implemented
process in 2006 and continues through 2013.
 Served as a senior lead and supervisor for groups of up to 20 personnel throughout tenure.
 Performed quality and process testing pre and post-system enhancement.
 Acted as a trainer, including the creation of training documentation as well as facilitating the training
sessions.
Education & Professional Training
Community College of Allegheny County, Pittsburgh PA
Computer Information Technology, American History and Archaeology.
Member of Phi Theta Kappa Honor Society
UPMC Health Plan Training
Microsoft Access Level 1 and Level 2
Microsoft Excel Level 1 and Level 2
HIPAA Code of Conduct and Ethics
PNC Training
Electronic Data Interchange – 27X, Microsoft Access, Microsoft Excel Intermediate Courses, Government Processing
Security Awareness Course, Employee Ethics and Risk Essentials, Technical Quality Center – ALM.
Received ten Spotlight Awards during 2012 for excellent work and assisting the team in meeting our goals.
Coventry Health Care Employee Training Courses
IDX Claim Payment System: Claim Payment Module, Accounts Payable Module and the Customer Service Module,
Training and Process implementation for Protected Health Information.
Volunteer and Community Events
• PNC’s Grow Up Great
o Volunteer for the Children’s Festival of Pittsburgh
o Volunteer to assist with classroom activities at local Pittsburgh schools
o Volunteer for the Pittsburgh Marathon – Welcome Event
• UPMC
o MOM-N-PA Dental Clinic Event Volunteer
o Children’s Hospital of Pittsburgh Weekly Friday Fun Day Volunteer