desiree duncan

business systems senior advisor - healthcare and life sciences

About

Desiree is a Senior Business Systems Analyst, focused on Healthcare payor enrollment, billing and claims processing initiatives. Desiree has over 10 years of experience in Medicare Advantage and Medicaid regulatory initiatives, helping her clients become compliant with state and federal programs including Medicare Part D, CAQH Core and Health Insurance Exchanges as a part of the Affordable Care Act. Desiree’s healthcare experience also includes PBM operations management and pharmacy claims. Specialities: Business Analysis | Project Management | Software Design | Testing | Client Facing Roles

Country

united states

City

tampa

Industry

information services

Skill

business analysis, process improvement, business requirements, call centers, requirements analysis, visio, business process improvement, sdlc, software documentation, vendor management, health insurance exchanges, pmp, program management, change management, data warehousing, integration, business intelligence, analytics, membership, requirements gathering, management, hipaa, ms project, sql, project management, sharepoint, business process, disaster recovery, data analysis, cross functional team leadership, compliance, healthcare information technology, software project management, u.s. health insurance portability and accountability act

Experience

software engineer

getronics

2001-1 - 2003-1 · 2 yrs 1 mo

Mid-level development and support of proprietary in-house software using Visual Basic, XML and XSLT

manager, operations support

walgreens

2006-9 - 2008-3 · 1 yr 7 mos

* Built new team on the Business Operations side to support the internal PBM claims adjudication software * Facilitated business interactions with IT for escalated issues and bug resolution, including working with IT to define processes, hand-offs and prioritization * Evaluated CMS Medicare Part D guidance as a part of a business SME team for impact on PBM business and IT processes * Involved in analysis and troubleshooting of Part D business data surrounding the TrOOP facilitation process, claims and eligibility data. * Participated in NCPDP Workgroup 1

business analyst and project manager

wellcare health plans

2003-1 - 2006-1 · 3 yrs 1 mo

* As a Sr. Project Manager, PDP Business Operations, including initiatives for systems integration with TMG Health for WellCare's PFFS offering, as well as PDP iniatives supporting IVR, EOB and premium billing/SPAP coordinationation * As a Sr. Business Analyst, worked extensively with WellCare's Medicare Part D PDP and MAPD implementations,, coordinating business processes and data transfers with the PBM. * Worked on multiple initiatives for in-house software, working with claims, eligibility and member premium billing

business systems senior advisor - healthcare and life sciences

ntt data services

2008-4 - Present · 18 yrs 6 mos

* Data mappings and business logic for HIX 834 Eligibility Transactions for both Issuer and State Based Marketplace clients * Monitors regulatory guidance, including HIX Eligibility processing, CAQH CORE and ICD10 * Facilitates client discussions of regulatory solutions, leading on-site JAD discussions between Dell BPO staff and client stakeholders * Performed BPO client product impact assessment for CAQH CORE Phases I, II and III * Performed ICD10 enhancements for Xcelys/Diamond product in multiple client environments * Worked on BPO client CMS Encounter Data initiative and 837 data mappings

Education

ball state university

1983-1 - 1987-1 · 4 yrs 1 mo

Graduate - Summa Cum Laude * Alpha Lambda Delta freshman honor society * Multiple theatrical productions * Ball State Singers Greece Tour and Fall Tour of Indiana high schools to promote the university Activities and Societies: Ball State Singers, Chamber Choir, Mu Phi Epsilon music fraternity, Ball State Theater, Ball State Equestrian Team