Barbara Green, MAOM **** Cedarcrest Drive

Mesquite, TX 75149

214-***-****

QUALIFICATIONS:

•Strong Billing, Collections and Reimbursement experience.

•Strong Audit, Quality Control/Compliance, Account and/or Project Management experience, Provider Contracts and Credentialing, Time-management, and 10 year Managed Care experience and 2 year manufacturing experience. Knowledge of health industry regulatory standards (i.e. NCQA, URAQ, and TDI).

•Several years multitasking experience - Projected Revenue, Budgeting and Financial Analysis experience. Payer and Provider claims knowledge, AMISYS, EMR or EHR knowledge.

•Healthcare, Revenue Cycle and Claims Management, UB-04, Risk Assessment, ISO, FDA, and FAR Regulations, Knowledge of State and Federal DOT Regulations, HIPAA training, 5yr Medical Office Supervision.

EDUCATION:

•Master of Arts, Organizational Management; Dec 2013

Healthcare Administration; GPA: 3.91

Ashford University, San Diego, CA

•Bachelor of Arts, Psychology; April 2012

GPA: 3.97 Magna cum Laude

Ashford University, San Diego, CA

WORK EXPERIENCE:

Xerox Services, Plano, TX Dec 2014 – Present

Medical Contracts Advisor (Contract Role)

Audit and process provider contracts/disclosures to determine if they are clean or unclean.

Enter contracts/disclosures into system database, if clean.

Contact providers to assist with the completion of disclosure forms.

Take provider calls to explain issues with disclosures.

Develops and maintains positive relationships with the providers by communicating administrative or programmatic changes and facilitating the resolution of provider issues.

Dell Services Inc., Plano, TX Feb 2008 –Feb 2014

Quality Control Supervisor & Billing/Collections Team Lead:

•Managed a team of six local Claims Auditors and 6 Auditors in different geographic locations to ensure the successful processing and audit of claims.

•Managed all functions of the accounts billing and revenue cycle to maximize cash flow while maintaining and improving internal and external customer relations.

•Served as primary contact for the project, regarding issues pertaining to the account as well as compliance concerns.

•Accomplished leadership functions such as hiring, providing performance reviews, training, mentoring, and terminating.

•Monitored and supervised the activities of the team to ensure Service Level Agreements (SLAs) were met.

•Worked with management team to establish department and company goals and relied on experience and prior responsibilities to attain them.

•Ensured daily lockbox deposits were balanced and applied accurately.

•Contacted clients who were delinquent to discuss accounts; processed refunds, adjustments, and credits when necessary.

•Provided alternative plans for clients, including payment plans and agreements; reduced aging reports from 90 to 120 days past due to zero; maintained required monthly SLA’s, prepared daily schedules and made adjustments according to the daily forecast.

•Reviewed clients billing cycles end to end and audited and reviewed invoices for assigned accounts.

•Pioneered several reports within billing department and worked with team to meet member’s needs, resolve issues and ensure overall member satisfaction.

•Performed data analysis, identified trends and issues, evaluated and provided recommended solutions for issues detected.

•Developed and implemented process improvements, and coordinated new audit designs. Transferred and loaded formulas required, utilizing SQL; Analyzed, evaluated and documented user needs and business requirements; reviewed various documents for compliance requirements and recommended necessary edits.

•Prepared reports regarding progress, effectiveness and outcomes of claims analysis and presented to upper management and staff.

•Provided recommendations for improvements and changes, and assisted with the implementation of changes as approved by management.

•Delivered accurate, detailed and timely analysis of new laws and regulations impacting the health plan operations to build and maintain compliance and avoid the potential for risk exposure.

•Recommended operational improvements and was responsible for the day-to-day application of organizational policies and procedures.

•Updated and edited knowledgebase with amendments to our written policies and procedures in order to assure compliance with any ongoing or new requirements.

•Communicated with state and federal regulators and assisted in maintaining compliance reporting.

•Experience importing, exporting, and manipulating complex data sets; Accountable for member’s accounts, billing, collections, enrollment, payer contracts, claims processing and audits, vendor relations and departmental goals.

•Monitored trends in healthcare compliance and communicated updates to health plan leadership and affected staff.

•Provided coaching, mentoring, development, guidance and timely resolution of issues within the team environment.

•Targeted root cause analysis through research.

•Responded to emails or phone calls from third party payers on challenges and denial of claims.

•Analyzed and managed quality metrics and managed resources and overtime while staying in budget.

•Performed as a role model for the team and insisted on respect for the organization as well as each other.

DTI Associates Inc., Dallas, TX Feb 2006 – Feb 2008

Team Lead-Recruitment Analyst:

•Submitted data into a computerized database from foreign labor applications submitted by employers who wish to employ one or more foreign workers.

•Audited labor applications to determine whether the information submitted was in compliance with federal regulations.

•Collaborated with attorneys, agents, or employers to communicate findings.

•Secured information from various sources including the Internet, to carry out on-line research.

•Exercised analytical and decision-making skills to perform subjective case analysis.

•Implemented other duties as assigned in a productive and timely manner.

•Assisted with recruitment activities and processes including candidate sourcing, screening and evaluation; Sounding board and resource to applicants in all matters involving their employment with a potential firm.

COMPUTER SKILLS: Microsoft Office Suite –AS400- HRIS-Kronos – Changepoint- Citrix-Crystal-Diamond-Xcelys- PeopleSoft-NDB- Knowledgebase-Oracle-SQL-SAP- ERP- Paradigm- AMISYS- EMR /EHR Implementation - Audit Tools- Data Analysis- ERP- Adobe Pro & Acrobat - Invoicing- GAAP-Credit and Collections- Receivables- General Ledger Maintenance.

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