Experience

Bon Secours Health System Inc

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

• Managed Care Analyst

  • Aug 2013 - Present

  Subject matter expert on contract management system. Liaise with contract management software vendor, market leadership, and Revenue Cycle Services to load, correct, and troubleshoot contract loads. Perform ad-hoc reporting upon request. Create and schedule standard reports to track payer mix and expected revenues for managed care payers. Analyze variance report for reimbursement discrepancies and trends. Communicate findings with Managed Care market leaders, Revenue Cycle leadership, Revenue Integrity and other departments impacted by the findings. Coordinate modeling of hospital contracts for renegotiation with payer. Suggest changes to proposed rates on behalf of the health system to maximize net revenue and minimize lesser-of impact. Show less



VCU Medical Center

• Richmond, Virginia Area

• Systems Analyst

  • Apr 2012 - Jul 2013

  Coordinated service request and system updates with GE IDX Dedicated Service Representatives on behalf of physician’s group. Responsible for testing and documentation of all system updates while adhering to change management policy. Created, updated, maintained, and documented electronic claim form logic upon request. Tested and validated all modifications. Provided ad-hoc reporting, as well as, created and maintained production reports for various areas of the billing and revenue cycle departments. Utilized GE IDX Report Writer, Cognos, and Tumbleweed for data extraction and report scheduling. Show less



Novant Medical Group

• Charlotte, North Carolina

• Managed Care Systems Analyst

  • Apr 2005 - Apr 2013

  Identified payment inconsistencies and offered front-end resolution. Contacted payer as appropriate to implement review and/or payment adjustments, resulting in increased revenue and accurate contract execution. Reviewed, loaded, and updated claims logic and audit edits. Extracted data from centralized billing system and billing departments of independent clinics in order to analyze financial impact of current and proposed Managed Care contracts. Attended monthly Joint Operating Committee meetings with top payers representing group interest on issues such as medical policy, fee schedules, payment discrepancies, payment recovery, and clarification on billing guidelines. Show less



Novant Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Quality Analyst/Educator

  • Apr 2003 - Mar 2005

  Responsible for training and testing new and existing Patient Access staff on process and procedures, registration guidelines, as well as updates and changes to department processes and computer systems as they related to patient registration and the revenue cycle for all payer types. Analyzed employee and departmental needs. Developed, implemented and evaluated educational activities.

• Insurance Verification Specialist

  • Mar 2003 - Dec 2003

  Verified coverage and benefits with commercial and government insurance carriers for inpatient and outpatient hospital services. Obtained authorization and performed notification for services when required.



The Lash Group

• Charlotte, North Carolina

• Reimbursement Counselor/Sr Reimbursement Counselor

  • Apr 2002 - Apr 2003

  Assisted medical providers with verification of benefits and eligibility, claims appeal assistance, claims follow up, and coding issues. Assisted policy holders with reimbursement and coverage issues in the form of appeals to the insurance company or the employer group benefit coordinator. Assisted medical providers with verification of benefits and eligibility, claims appeal assistance, claims follow up, and coding issues. Assisted policy holders with reimbursement and coverage issues in the form of appeals to the insurance company or the employer group benefit coordinator.