Description
Effective * Worked diligently with the Health Plan Manager, Case Management, and Third Party Administrator (TPA) to monitor costs and cost savings for Hilmar Cheese Company's Self Insured Health Plan * Successfully established reporting metrics and data analytics which detailed health plan performance, employee and healthcare utilization, advanced clinical analysis, and utilization indicators * Enhanced the monthly health plan cumulative report to more accurately reflect actual health plan costs and expenditures by collecting "true" and validated numbers and granulating them by line item to illustrate factual health plan costs throughout the plan year * In conjunction with the Health Plan Manager, developed an Executive Health Plan Quarterly Report for the Chief Financial Officer (CFO) which included quarterly and year-to-date health plan costs and was presented at Board and Steering Team meetings to demonstrate health plan performance and associated cost * Instrumental in developing and strategically implementing procedures and guidelines to meet all Affordable Care Act (ACA) requirements and compliance regulations * Worked with our TPA to accurately gather and audit employee personnel information to identify incorrect/erroneous data and modify with revised corrections * Established an accurate database which was then used to retrieve required ACA and other government required submission data for 1095-Cs, 1094-C, Transitional Reinsurance, and Patient- Centered Outcome Research Institute (PCORI) Fees * Meticulously audited employee/census monthly premium billing report to validate current employee & dependent health plan eligibility and reconcile premium billing invoice * Active and contributory in the Benefit Focus Advanced Analytics implementation and post implementation including data verification and the development of custom report writing and the modeling support required to determine the health plan changes and/or recommendations * Developed a comprehensive invoice tracking system to record department invoices and expenditures * Responsible for generating and reviewing daily Case Management Reports to determine healthcare utilization, severity of illness, level of care and/or if immediate attention or action was required on behalf of the plan member * Successfully developed and reconciled data mining reports (e.g., High Dollar, Variance, Cobra, Check Run, Transaction Register to closely monitor health plan costs to manage and eliminate risk, detect fraud and anticipate resource demands * Validated monthly incurred but not reported (IBNR) report to estimate the amount owed on all member claims with covered loss that have not yet been reported, coupled with the health plan reinsurance to project necessary reserves to pay future claims * Solid in the Interpretation of data requirements using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining * Knowledgeable in Health Plan processes, strategies, applications and data relationships to derive data analysis and reporting needs * Familiar with Health Plan claims data elements, claims processing and medical claims analysis/charge audit * In conjunction with the Compensation & Benefit Manager, compiled tables of employee wage data in preparation of the annual compensation analysis for hourly positions Mendoza pg. 2 * Trusted with access to annual salary data for all levels of employees, including director and executive * Efficiently and accurately processed benefit enrollments into the HRMS system to include monthly new enrollees, and on-going additions, changes, and terminations * Consistently audited benefit enrollment data between HRMS and TPA records to ensure consistency across data warehouses * Successfully coordinated and executed the annual benefit fair and flu shot clinic in Hilmar, CA and Leadership in decisions related to best method problem resolution
Accomplishments
Highlights:
Keywords
