Professional BackgroundHighly motivated professional seeking opportunity to obtain a challenging position with Florida Blue that will fully allow me to utilize my education, skills, loyalty and work ethics where initiative and accomplishments will be the basis for professional advancement and mutual growth. Technical SkillsMicrosoft Windows 8, Microsoft Word, Excel, Outlook, PowerPoint, Access.Provider Information Platform (PIP), Diamond DFS, Diamond Maintenance Tool PROD DFS (DMT), PFE, IMS, EVerify, FedEx shipping and tracking, UPS shipping and tracking.Siebel queue inventory management, and Client Letter.Experience in building and Maintaining strong business relationships.Experience with health care industry, business related process and delivery system.Strong written and verbal communication.speak and write both French and Creole.Critical thinking Education and TrainingBachelor of Science Health Service Administration,Expected in2014toUniversity of Central Florida-Orlando,FLGPA Health Service Administration Professional ExperienceProvider Data Service Analyst II,04 2010to09 2015National Vision Grand Rapids,MI,Duties include preparation and execution of provider contracts, loading contracts fee schedules and benchmarks, maintaining provider data such as demographic information.Problem solving to ensure contract arrangements enable the accurate adjudication of claims payments and assistance in contract administration.Identify trends and problems through an assessment of practices, and develop new processes and activities and build a business case for execution, incorporation or adaptation.Participation in the creation of, and compliance with, provider policies and procedures dealing directly with dedicated provider groups.Ensure appropriate investigation and issue resolution, loading and maintenance of contracting arrangements containing several lines of business for provider contracts and provider demographic data in multiple claims administration systems, including but not limited to PIP (Provider Information Platform) and Diamond DFS.Configures provider payment arrangements through integration of provider contractual arrangements, product benefit standards, in order to facilitate accurate claims payment.Coordinate with operational areas and other departments within the delivery system such as network management for due diligence.Resolves provider data and payment discrepancies by interpreting contract language and apply appropriate pricing methodologies and contractual arrangements to facilitate accurate and timely resolution of provider claims payment issues.Build and maintain strong relationship business relationship whether internal or external.Provide dedicated management of provider demographic data and contract arrangements for Minute Clinic, Take Care Health, and CareSpot.Ensure integration and coordination with all Florida Blue Operational areas.Consultant on development of business requirements for provider maintenance and contracting under new Provider Information Management System (PIMS).(Analyst II) Contractor,04 2010to01 2012Blue Cross Blue Shield Of Florida City,STATE,Duties include coordination of contract loads and maintenance of provider data files.Experience in collaborating and building strong relationships with internal and external business partners promoting positive results.Negotiating with external business partners to achieve and influence customer outcomes and meet the targeted set leadership goals.Coordinate activities for continuous improvement efforts.Perform special projects tied to managing territories targeted for Network expansion and associated priorities, action plans and tasks set to meeting targeted outcomes.Perform and lead special initiatives by identifying, developing, recommending, and implementing process, procedure and product.Proficiency in interpreting provider reimbursement methodologies.Coordination with business partners and network management on fee schedule builds that apply to contract reimbursement.In depth knowledge of provider payment programs and billing practices such as coding, subject matter, expert tools (PIP, Diamond, Siebel, DMT, Online Provider Directory and other delivery system tools) and processes to support temporary resource projects.Responsible for following all process and procedures for the four core PPDO business processes, of which include Contracting, Registration, Maintenance and Termination.Confirming that information loaded to provider s files interface to all systems and loading necessary fee schedule history of HMO, MM, NWB, NWMBA, PPC, PPS, MDS, MDB, BSC and PFS lines of business.Assistant Manager,11 2006to07 2009Seven-Eleven City,STATE,Prepared and presented training materials to new employees.Ensured that the store met CDC regulations by regularly performing inventory reports.Monitor, evaluate, and take action to improve individual and team target goals.Planned and established work schedules (e.g., vacations, work shift, coverage for absent team members.)Provided motivation, inspiration, and developmental support to staff through coaching, providing feedback, reward and recognition. Skillsbilling, BSC, business case, business processes, cashiering, coach, coaching, Consultant, continuous improvement, contract administration, contracts, Client, excellent customer service, delivery, due diligence, French, health care industry, IMS, inspiration, Internet Explorer, inventory management, inventory, team building, leadership, leadership skills, managing, Microsoft Access, Microsoft Excel, Microsoft Outlook, Microsoft PowerPoint, Microsoft Windows 7, Microsoft Word, Negotiating, network management, Network, organizational skills, performance appraisals, policies, presenting, pricing, Problem solving, processes, producing, coding, project management, shipping, Siebel, training materials, verbal communication skills, written  SEP  Job Description Java Developer Lead I - Software Engineering Who We Are Born digital, UST transforms lives through the power of technology. We walk alongside our clients and partners, embedding innovation and agility into everything they do. We help them create transformative experiences and human-centered solutions for a better world. UST is a mission-driven group of over 29,000 practical problem solvers and creative thinkers in over 30 countries. Our entrepreneurial teams are empowered to innovate, act nimbly, and create a lasting and sustainable impact for our clients, their customers, and the communities in which we live. With us, youll create a boundless impact that transforms your careerand the lives of people across the world. Visit us at UST.com . You Are UST is looking for Java Developer for one of the leading healthcare providers in the United States. The Opportunity Interpret the applicationfeaturecomponent design to develop the same in accordance with specifications.Code, debug, test, document, and communicate productcomponentfeature development stages.Validate results with user representatives integrates and commission the overall solutionSelect appropriate technical options for development such as reusing, improving, or reconfiguration of existing components or creating your own solutionsOptimizes efficiency, cost, and quality.Influence and improve customer satisfaction This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Need Resource with at least 8 plus years of experience in JavaJEE space in an Agile environment. Strong hands-oncoding experience is a must and below is the key experience area that is required JavaJ2EE Spring Framework (Core, MVC, Web Services, Integration Suite, Spring Data)Web Services (SOAPREST)Spring Batch FrameworkSpring BootSpring MicroservicesHibernateExtJS Framework, JSP, Java ScriptsMongo DBIBM DB2 RDMS ConceptsJUnit Unit Testing frameworks Good to have Knowledge of Drools FrameworkKnowledge of Angular JS FrameworkKnowledge of Bit BucketExperience working in JIRAExperience working in AWS Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York City, or Washington as set forth below. Role Location Range of Starting Pay for Role Remote 73,000- 109,000 Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. Depending on the role, some associates may also be eligible for stock options. What We Believe Were proud to embrace the same values that have shaped UST since the beginning. Since day one, weve been building enduring relationships and a culture of integrity. And today, it s those same values that are inspiring us to encourage innovation from everyone to champion diversity and inclusion and to place people at the center of everything we do. Humility We will listen, learn, be empathetic, and help selflessly in our interactions with everyone. Humanity Through business, we will better the lives of those less fortunate than ourselves. Integrity We honor our commitments and act with responsibility in all our relationships. Equal Employment Opportunity Statement UST is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization andor your performance.

ATS compatibility: No Fit (score: 25.5)