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Job Opportunity Respondance

Passaic, New Jersey, 07055, United States
June 07, 2008
Contact Info:


*** ******* *** • Passaic NJ *7055

********@*******.*** • 973-***-**** • cell 973-***-****

OBJECTIVE A position in Healthcare or Pharmaceutical sector/Coordinator /Manger/Healthcare Auditor.

Extensively experienced and goal-oriented healthcare professional with strong leadership capabilities with a demonstrated track record of leading the preparation and analysis of financial skills in healthcare and pharmaceutical sector. Proven expertise in driving efficiency and productivity through evaluation of financial and implementation of process improvements. Proven ability to work in unison with staff, volunteers, and board of directors. Organized, highly motivated, and detail-directed problem solver. Areas of strengths include:

• Sales

• Contract Management

• Medical Claims Coding • Cash Management

• Mentoring/ Trainer

• Implementation • Reconciliation/Collection

• Regulatory Compliance

• Troubleshot & Resolving Problems


MEDCO HEALTHCARE SOLUTION, Franklin Lakes, New Jersey, 2006 –2008

Client Auditor-UHG and BOB Account

Managed all aspects of client audits to ensure regulatory compliance and operational efficiency/accuracy in various assigned audits. Consistently met deadlines while demonstrating strong analytical and problem-solving skills to achieve corporate objectives. Built and led teams in carried out special projects. Troubleshooting various system issues in order to be resolution to the problems. Priced out and re-priced claims at Mac, ACQ, AWP, U &C or at any other HMO discount price to resolve any discrepancies. Analyze and researched pharmacy and manufacture contract for audit support as well as resolving system control issues that impact clients and determines financial impact. Work as a financial liaison along with Account Management and other department to resolve issue. Log all audits reports in database. Gave informative presentation to management and client as well as prepared audit reports with appropriate support. Traveled to various site to oversee onsite audits. Help assist in training any new auditor.

AIM HEALTHCARE SERVICE, Franklin, Tennessee, 2003 – 2006

Lead Regional Account Manager (NY and NJ area)

Conducted audit reviews on credit balance with capitalization of over $1.5 million to ensure regulatory compliance with applicable rules, regulations, laws and agreements of managed care guidelines for 14 hospitals. Interacted with facilities contract management to calculate and analyze rate adjustments for Medicare, Medicaid, and HMO rates. Analyze UB92 forms, explanation of benefits, ICD codes, financial systems and DRG classification to process follows-up and reconciliation of claims. Interaction with contract management to analysis insurance contract to determine contracted rate of pay as well as recommended correction adjustment and cash transfer to various accounts. Projected AIM monthly-accrued revenues including AR/AP, account reconciliation, and cash management. Reported new insurance sales leads that would help expand the territory and build new business relationship with prospective insurance. Built and led teams in carrying out special projects. Oversees AIM staff in daily duties, mentored and trained new Account Manager and EOB puller’s on reconciliation procedure for facilities.

MERCY COLLEGE, Dobbs Ferry, New York, 2000 – 2003

Branch Office Manager for Bursar/Registrar

Overseen daily operations of the business/registrar office and staff at the White Plains and Manhattan campuses. Prepared paperwork for undergraduate and graduate admission, registration, billing correction, refunds and tuition payments. Received and disbursed cash for campuses budgets needed. Recorded all transactions and reconciles cash daily for cashiering. Made daily bank transaction deposit. Managed daily cash posting and collection. Calculated student loans totals for billing purposes. Worked on varies projects to promote student enrollment. Maintained effective relation with the students.

LENSCRAFTER, White Plains, New York, 1998–2000

Associate/Captain of the Gift of Sight

Sold prescription eyeglasses and verified doctor prescription. Entered customers’ personal information data, prescriptions, and pupil distance measurements. Possess knowledge of insurance information and helped customers with questions and merchandise. Processed cashiering transaction. Handled CSAT reports and daily sales operation. Conducted various vision projects at nursing homes, and school to promote better vision by supplying eyeglasses and free exams.

THE FAMILY MEDICAL OFFICE, Larchmont, New York, 1997–1998

Office Manager/Medical Assistant

Made patients’ appointments and collected any fees for visits. Updated patient charts and utilize PC to enter and retrieve patient data. Ordered vitamins supplement and office supplies for the office. Assisted the doctor in patients’ therapy and ordered lab work and x-rays. Verified patients’ insurance coverage as well as maintained accounts information and generated bills. Entered patient personal information into the computer and managed all daily operation and staff. Conducted daily bank deposits and general office duties. .


Bachelor of Science, Health Service Management (2003)

MERCY COLLEGE – Dobbs Ferry, New York

HIPPA Training-2003

Westchester County College-Valhalla, NY

EMT Training Course -1999


SOUND SHORE MEDICAL CENTER-New Rochelle, New York (1993)


SMS/ RAS/ Series 2000/ MEDITECH/McKesson HBOC/AS400/ Eagle Systems/ Invision/ Rumba/ CMS/ Windows XP/ MS Access/ MS Excel, MS Word, Publisher, Power Point, Outlook/ Novel/ CorelWordPerfect2000/AS400/Medwatch/Mainframe/IDF/eSD/FRP/