CHOMEKA
JONES
832-292-2589 • [email protected] • Fresno United States
PROFESSIONAL SUMMARY
Results-driven Configuration Analyst with over 16 years of healthcare systems expertise. Specializing in
system migration, optimizing provider data accuracy, and leading cross-platform configuration
builds. Recognized for streamlining deployment processes, comprehensive testing/validation, and
enhancing system reliability. Skilled in SQL reporting, data analysis, and maintaining regulatory
compliance. Adept at mentoring teams, resolving complex issues, and providing actionable insights
for operational efficiency. Proven track record in improving Medicaid/Medicare data accuracy,
managing vendor contracts, and enhancing system performance. Passionate about driving
continuous improvements in dynamic healthcare IT environments. Adept at strategic management,
optimizing billing processes, and managing provider setup for seamless transitions.
SKILLS
Adaptability JSON manipulation
QNXT SQL Server Reporting Services
Facets Systems Analysis
Epic (Tapestry) Systems Integration
Data Interpretation Scrum Methodology Expertise
System Reliability Assessment Proficient in Statistical Methods
Medicaid Business Technologies
Medicare PFFS Certified Medical Technologist
Commercial Managed Care Administration
Regulatory Standards Enforcement Medical Billing and Coding
Proficient in Career Growth Strategies Business Analysis
Contract Management Accounts Receivable
Database Optimization Payment Processing
Microsoft SQL Server Administrative Operations
Regression Testing Quality Management
Regulatory Requirements Gathering Metrics
Customer Relationship Management Maintenance
Systems Testing Microsoft Suite
Mentoring Subject Matter Expert (SME)
Standard Operating Procedures Provider Setup Management
Insurance Claim Management Benefit Engine
Health Care Management Utilization Management (UM)
Configuration Management Python for automation
Python
EXPERIENCE
CONFIGURATION ANALYST
Texas Children's Hospital | Bellaire | Jul 2022-May 2024
Achieved system enhancements in compliance with TMHP and CMS guidelines, which improved
Medicaid data accuracy.
Facilitated the transition from QNXT to Tapestry by configuring EPIC/Tapestry vendor contracts
with required specifications.
Configured benefit plans with Tapestry Benefits Engine and UM guidelines within healthcare
systems (QNXT, Epic Tapestry) to ensure compliance with Medicaid CHIP, STAR and STAR KIDS
payer regulations
Analyzed and implemented UM protocols for prior authorizations, referrals, and medical
necessity reviews, enhancing claims accuracy by 20%
Streamlined feature addition and upgrade processes in Epic (Tapestry) systems, ensuring smooth
and timely deployments to support efforts for benefit configurations and automated
adjudication workflows reducing claim processing time by 30% for high-volume claims
Collaborated with cross-functional teams to align UM processes with healthcare benefits,
ensuring timely processing of claims and reducing provider disputes
Reduced provider abrasion rates by 15% through rigorous Systems Testing (Unit, Integration, UAT)
and regression testing, enhancing system reliability and user experience during the QNXT to
Tapestry migration
Boosted database performance with advanced SQL Server tuning techniques, resulting in a 20%
decrease in query response times and improved system performance
Developed Python scripts to automate data extraction and transformation processes,
converting raw provider and claims data into JSON format for seamless integration across
multiple systems.
Created and maintained JSON-based APIs to streamline data exchange between credentialing
platforms and claims processing systems, improving data accuracy, and reducing processing
time by 35%.
Enhanced system reliability by identifying and resolving data discrepancies using Python and
JSON.
Managed claim document reviews and contract updates through optimized CRM's in Epic
(Tapestry).
Validated system builds through IFC test cases ensuring readiness prior to production
deployment.
Facilitated vendor contract negotiation and management, realizing cost savings and enhanced
service levels.
PROVIDER INSTALLATION ANALYST
Texas Children's Hospital | Bellaire | Apr 2019-Jul 2022
Oversaw CHIP, STAR, and STAR Kids Medicaid provider data in QNXT, Cactus, and Epic Tapestry.
Led configuration builds and testing, improving system reliability by 10%, and supporting key
projects during the migration from legacy systems to Epic Tapestry.
Enhanced data integrity by addressing Provider issues in significant datasets through Python
scripting and JSON.
Served as a SME, leading mentoring efforts that boosted operational effectiveness and refined
provider configurations.
Spearheaded provider configuration initiatives as an SME, resolving complex issues and
enhancing team expertise, leading to a 20% boost in operational efficiency
Enhanced workflows and project turnaround times, resulting in a 25% boost in team productivity.
Facilitated system migration from QNXT to Epic Tapestry, ensuring smooth transitions and minimal
disruptions.
BILLING REPRESENTATIVE II
Memorial Hermann | Houston | Nov 2018-Apr 2019
Developed accurate billing processes for Athena and Health Edge Source platforms
Optimized billing processes to reduce discrepancies in high-volume transactions
Performed data analysis on ambulatory metrics, increasing operational efficiency by 15%
Generated actionable insights to inform business decisions by utilizing statistical analysis on large
data sets
Managed payments, credits, and invoices for patients efficiently
SENIOR HEALTHCARE DATA ANALYST
Aetna Healthcare | Houston | Jun 2007-Jul 2018
Managed Commercial and Medicare PFFS provider data integration for utilization reviews,
ensuring accurate representation of provider services in alignment with benefit plan
requirements, provider data for Behavioral Health providers across IDX (Facets), Navigator, and
QNXT, ensuring compliance with regulatory standards
Led configuration builds and testing, improving system reliability by 10% and supporting key
projects during the migration from legacy systems to QNXT
Mentored and guided junior analysts as a Subject Matter Expert (SME), resulting in a 20%
increase in operational effectiveness and improved provider configuration processes
Spearheaded provider configuration initiatives as an SME, resolving complex issues and
enhancing team expertise, leading to a 20% boost in operational efficiency
Increased team productivity by 25% by developing and implementing standard operating
procedures (SOPs), streamlining workflows, and improving project turnaround times
Supported system migration efforts from IDX (Facets) to QNXT, ensuring smooth transitions,
minimal disruptions, and improved provider data accuracy for Behavioral Health providers
Developed and maintained UM data sets and reporting tools to monitor provider compliance
with benefit plans, driving informed decision-making in healthcare delivery
Led data analysis efforts to identify UM trends and outliers, resulting in a 15% improvement in
claims management and provider network efficiency
Managed provider data integration for utilization reviews, ensuring accurate representation of
provider services in alignment with benefit plan requirements
Coordinated with medical directors to update UM rules based on regulatory changes, ensuring
adherence to the latest policies and enhancing the quality of care
Improved provider setup accuracy using IDX/Facets and QNXT platforms, contributing to data
consistency and compliance for Commercial and Medicare PFFS plans
Led the system migration from IDX (Facets) to QNXT, overseeing go-live efforts and staff training
to ensure a seamless transition
Resolved complex provider configuration issues as an SME, enhancing system efficiency and
maintaining operational integrity during the IDX to QNXT migration
Collaborated with cross-functional teams to design data-driven enhancements, improving
system performance and workflows
Developed KPI reports using Visio, improving decision-making and ensuring compliance with
regulatory standards
Identified process inefficiencies and provided actionable recommendations, leading to
improved workflows and operational performance
EDUCATION
Bachelor of Science
University of Houston
Associate of Applied Science
Houston Community College
WEBSITES, PORTFOLIOS, PROFILES
http://linkedin.com/in/chomekadjones
LICENSES
Tapestry Claims and Contract Administration, EPIC, 07/01/23, Present
Certificate in Business Technology, 12/01/07, Present
Tapestry Essentials, 07/01/23
