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.
The convergence of health plans and healthcare providers has led to the growing importance for provider-led health plans (Payviders). This eBook highlights the data and technology capabilities necessary for Payvider organizations to optimize performance and drive operational efficiencies.
The convergence of health plans and healthcare providers has led to the growing importance for provider-led health plans (Payviders). This eBook highlights the data and technology capabilities necessary for Payvider organizations to optimize performance and drive operational efficiencies.
A seminar topic which was created for the first time easy to understand and easy to explain.
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Major Hospital Embraces Role Based Access ControlHanno Ekdahl
A large mid-western hospital group had grown by acquisition and integration of new facilities. The resulting complex structure of hospitals, medical schools, and clinics has created a difficult environment for managing identities and access to critical clinical systems. Requesting and fulfilling access requests for critical roles is time-consuming manual work. Role Based Access Control (RBAC) offered a framework to improve user access management efficiency and effectiveness.
Approach to enable your IT systems for FHIR (HL7 standards) complianceShubaS4
This summary deck discusses a practical, step-by-step approach to transform your IT systems for FHIR (HL7 standards) compliance, API-enablement of your legacy for an accelerated go to market using a library of tools and frameworks under the DigitMarket umbrella. It outlines different integration challenges such initiatives encounter and equips you to plan your compliance roadmap for FHIR.
A seminar topic which was created for the first time easy to understand and easy to explain.
any queries related to this topic can ask to me. and be free to connect to me.
to connect me to fb search mykeel vineeth thelakat.
Major Hospital Embraces Role Based Access ControlHanno Ekdahl
A large mid-western hospital group had grown by acquisition and integration of new facilities. The resulting complex structure of hospitals, medical schools, and clinics has created a difficult environment for managing identities and access to critical clinical systems. Requesting and fulfilling access requests for critical roles is time-consuming manual work. Role Based Access Control (RBAC) offered a framework to improve user access management efficiency and effectiveness.
Approach to enable your IT systems for FHIR (HL7 standards) complianceShubaS4
This summary deck discusses a practical, step-by-step approach to transform your IT systems for FHIR (HL7 standards) compliance, API-enablement of your legacy for an accelerated go to market using a library of tools and frameworks under the DigitMarket umbrella. It outlines different integration challenges such initiatives encounter and equips you to plan your compliance roadmap for FHIR.
I am a customer focused technical resource who is seeking full time employment in the greater Atlanta area. I am a problem solver with a proven record for success.
Analytics leader optimizing clinical & operational services with high integrity partnerships, frictionless processes and shared data. Tactful engineering manager (five years) delivering self service automated BI/data applications and analyses that drives service transformation towards benchmarked quality and efficiency outcomes, often across multiple delivery modes (inpatient, ASC, medical group, pharmacy, lab) and insurance contracts (providers, groups, products, ACOs). Expert (16 years) in developing data services into actionable/modifiable descriptive trends/variances, predictive, and prescriptive analytics to optimize healthcare service decision making.
Independent consultant since 1996 with over 30 years of experience with Healthcare Information Systems; Expertise in healthcare industry, project management, business analysis, business administration/operations, Electronic Data Interchange (EDI), Electronic Medical Record (EMR), Physician Practice Management (PM), Health Information Exchange (HIE), testing, training, support and consulting; Experience working directly with providers, payers, software manufacturers, electronic data interchange organizations, billing services, clearinghouses and government agencies; Excellent skills for communication, technical research and problem-solving. Efficient and effective leadership for cost effective solutions.
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
2. C harles Bell Page 2
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