Frances Chu

Financial Analytics Manger @IEHP

Manage 10 team members.*Create stored procedures, functions, queries in SQL and SSRS reports and advanced in Excel *Hands on experience in member level revenue reconciliation, claims utilization and trend analysis.*Prepare and review State rate development templates and various SDRs such as Hospital SDR, BHT, Age and others.*Assist in quarterly orange blank submission to the State *Oversee month-end closing and GL entries.*Oversee monthly supplemental billing for maternity, Hep-c, health home, AIHS, LTC and HCBS programs.*Develope and maintain Proposition 56 (Prop56) and Ground Emergency Medical Transportation supplemental payments from data extraction to dispute process (successful implementation from the start of this program in which IEHP was one of the first six health plans in California meeting the State’s requirement and payment deadline.)*thrive on process improvement, cross training, and creating dash boards for leadership team *Lead other projects such as Medicare Part D drug, claims refund reconciliation, eating disorder payment and annual DSH hospital report and reconciliation.*Develop 834 to 820 to CPR reconciliation down to member-level and rate component.*Resolved multiple data issues pertains to revenue, membership, IPA encounters and provider billing.*Work closely with Data Science team and Claims Department on various projects to clean up data warehouse, claim system logic, and recommend changes.*Assist Actuarial, Pharmacy, Quality Systems, and Financial Compliance teams for their reporting needs.*Comprehensive knowledge in Healthcare operation. and wide-range experience in Healthcare finance, claim billings/ processing, contract, DOFR, IBNR, compliance audits.