Experience

Innovista Health

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Senior Application Specialist, IT

  • Ağu 2016 - - Halen



Valence Health (now Evolent Health)

• Hospitals and Health Care
• 100 - 200 Employee

• Claim Operations System Configuration Supervisor

  • Şub 2016 - Tem 2016

  Responsible for management and oversight of the Claims Department, specifically, the maintenance of benefit, provider and reimbursement data, to ensure timely of claims. Responsible for management and oversight of the Claims Department, specifically, the maintenance of benefit, provider and reimbursement data, to ensure timely of claims.



Unified Physicians Network

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Manager Claims Operations/Data Analyst/ Security Officer

  • Mar 2010 - Şub 2016

   Lead portions of the BCBSIL Delegation Compliance Audit Team for Unified Physicians Network, site 145, and achieved 96% Claims Payment Adherence and 99% Policy & Procedure and System Reporting compliance Worked with managed care software vendor and payers as a Beta site to submit proprietary file transactions including QIRA, MOOP, and Claim Encounters Project Management lead on new 5010 data transactions; 837, 835, 834 Increased electronic claims submission from 10% to 80% Developed electronic claims processing and auditing procedures Implemented managed care software (Quick Cap 6) for business operations Retooled and streamlined Eligibility and Capitation processes Drafted HIPAA & HITECH policy and procedures as IT member of HIPAA Compliance & Implementation team Developed Reports for Provider Relations and Network Development to identify areas with limited provider coverage, high cost providers, PCPs referring out of network and routine and urgent care access issues Created all reports utilized by the Quality Department for quality and clinical studies resulting in increased performance and revenue Deployed new document management system (M-Files) Installed New IP Phone System