Experience

Health Partners Plans

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Compliance Specialist

  • Feb 2022 - Present

  Revenue Recovery and QA duties, claim review and expedited processing. Utilize EPIC & Navinet among other systems to investigate unresolved heath claims for clients such as UPENN Hosp, Penna Hosp, Lancaster General, Independence Blue Cross, Princeton Hosp, CIGNA, Humana amongst many others. Revenue Recovery and QA duties, claim review and expedited processing. Utilize EPIC & Navinet among other systems to investigate unresolved heath claims for clients such as UPENN Hosp, Penna Hosp, Lancaster General, Independence Blue Cross, Princeton Hosp, CIGNA, Humana amongst many others.



Allied Universal

• United States
• Professional Services
• 700 & Above Employee

• Security Professional

  • Jan 2018 - Present

  Protection and surveillance of high rise corporate headquarters utilizing foot patrol, computer and closed circuit TV technology and security access controls. Protection and surveillance of high rise corporate headquarters utilizing foot patrol, computer and closed circuit TV technology and security access controls.



Independence Blue Cross

• United States
• Insurance
• 700 & Above Employee

• Quality Business Analyst_Commercial, Medicare Claims and Medicare Enrollment

  • Nov 2001 - Dec 2017

  OBJECTIVE: QA/Business Analyst with analytical skills in Commercial & Medicare insurances with previous experience in provider claims billing & appeals culminating in a 17 year career within the healthcare insurance industry. Ready to take on increased responsibility in the role of a Quality Business Analyst.EXPERIENCE: • AUDITOR: Critical audit of Medicare HMO & PPO commercial and Medicare members, looking to identify systemic and manual processing errors & assist our business partners in spearheading efforts to improve effectiveness as a QA Department. • DATABASE MANAGEMENT: Retrieval of various Medicare member enrollment transactions via internal databases used to assess processor accountability and accuracy as stated by CMS guidelines. • FEEDBACK: Provide feedback to our business partners to assess any errors found and work to improve the adjudication of system processes and associate knowledge.• EDUCATION: Help to create SOPs and cross train Medicare QA associates on various work streams within Claims & Enrollment QA.STRENGTHS • Understanding of in-depth Commercial and Medicare HMO and PPO claims analysis.• Understanding of Medicare member Enrollment transaction processing.• Understanding of CMS guidelines.• Familiarity with various database systems, imaging and processing applications. Also Microsoft Word, Powerpoint and Excel.• Willing to learn new areas of knowledge and assist in the completion of all deliverables necessary to the Department.• Willing to train other QA Associates on Claims & Enrollment QA analysis to maintain departmental inventory benchmarks

• Quality Assurance Specialist

  • Nov 2001 - Dec 2017

  Areas of expertise include: Quality Assurance  Data Analysis  Staff Training & Leadership Auditing & Research  Medicare Enrollment & Appeals  Process Improvement HMO & PPO Claims  Routine Reporting  Problem Resolution



Reimbursement Technologies

• Conshohocken, PA

• Provider Appeals Follow-up Specialist

  • Aug 1998 - Nov 2001

  Emergency room physicians billing - claims appeal specialist. Trained and knowledgeable in Medicare, Managed Care and Commercial policies. Identified and resolved issues and non-payments with the insurance companies in order to recover monies. Identified incorrect policy procedure and valuate the loss in company revenue. Create an effective response measure. Emergency room physicians billing - claims appeal specialist. Trained and knowledgeable in Medicare, Managed Care and Commercial policies. Identified and resolved issues and non-payments with the insurance companies in order to recover monies. Identified incorrect policy procedure and valuate the loss in company revenue. Create an effective response measure.



Sheraton Hotels

• Security Agent

  • Aug 1998 - Jun 1999

  Monitor and protection of hotel property and patrons. Monitoring via closed circuit cameras. Visual check of all employee & patron identification. Contact with local law enforcement. CPR trained. Monitor and protection of hotel property and patrons. Monitoring via closed circuit cameras. Visual check of all employee & patron identification. Contact with local law enforcement. CPR trained.



Wyndham Franklin Plaza Hotel

• Hotel Security Agent

  • Aug 1995 - Aug 1998

  Same. Same.



Bally Total Fitness

• United States
• Wellness and Fitness Services
• 500 - 600 Employee

• Sales, Health and Fitness Coordinator

  • May 1992 - Jan 1995



Silo

• Retail
• 1 - 100 Employee

• Assistant Sales Manager

  • Jun 1987 - Mar 1991

  Retail sales of electronics, home appliances and computer products. Hired and trained sales associates. Retail sales of electronics, home appliances and computer products. Hired and trained sales associates.



SILO Stores

• Assistant Manager

  • Aug 1987 - Jan 1991

  Training of new hires on all appliances, white goods, stereos, TV and computer equipment. Cash register accountability. Customer service oversight. Training of new hires on all appliances, white goods, stereos, TV and computer equipment. Cash register accountability. Customer service oversight.