Customer Service Quality Assurance
Resume:
Linda McBride
Health Benefits Administrator, MBA
North Canton Ohio 44720
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PROFESSIONAL PROFILE
MBA Health Administrator with over 10 years of experience leading and executing health administration processes and
systems. Implementing and coordinating annual enrollment and creation of plan specifications. Effectively handle
issue and escalation resolution, including root cause analysis and implementation of long-term solutions. Exhibiting
high ethical standards and knowledge and understanding of applicable health and welfare benefits related laws and
regulations affecting national health care.
SUMMARY OF SKILLS AND QUALIFICATIONS
Leadership, guidance, coaching, and staff development skills, as well as, conflict resolution.
Technical and software acumen utilizing statistical tools to evaluate data and to reach probabilistic solutions.
Oversee the Request for Proposals (RFP) bid renewal process and Request for Information (RFI) with Third Party
Administrator (TPA) and contracted vendors.
Tracking stop loss and reinsurance reimbursements, subrogation claims, tracking arrears, COBRA, HIPAA, FMLA, and Life.
PROFESSIONAL WORK EXPERIENCE
City of Canton – Human Resource Benefits Administrator
Canton, Ohio January 2009 to Present
• Leading and overseeing all Benefits Administration operational activities for Self-Funded Section 125 Plan.
• Overseeing the development and execution of health and welfare benefit administration processes and systems.
• Directing all aspects of the medical, dental, vision and pharmacy benefits, as well as, COBRA, life, and disability
policies.
Developed Wellness Program for employee population.
• Presenting benefit related issues to organization’s leadership team, broker, legal council and City Council officials to
provide review of reporting and interpretation of applicable policies and procedures.
• Monitoring system processes, benefit interface file execution.
• Customer Service solving complex problems and issues.
• Negotiating with third-party vendors, contractors, and business partners for cost effectiveness of benefits program.
• Researching HR benefit industry trends and developments.
• Ensuring benefits contracts meet State and Federal laws, HIPPA guidelines and social service benefits verification.
• Researching and recommending amendments to contracts as needed.
• Tracking stop-loss and reinsurance contract arrangements.
• Communicating benefit to employees and dependents, healthcare reform and PPACA regulations.
Adjunct Instructor October 2009-Present
Malone University College, Canton Ohio
Brown Mackie College, Akron Ohio
Linda McBride
Providing education and training through online and ground class structure to a diverse population of adult students
entering the field of Healthcare and Health Management. Teaching the principles, concepts and methodologies relating to the
delivery models, finance and legal aspects of healthcare, and community or public health.
Patient Financial Service Department Manager
North Canton Medical Foundation, North Canton Ohio November 2007 to June
2008
Managing all aspects of the billing and coding staff within the foundation.
Collaborating with other departments in developing and improving clinical and administration policies and procedures
and streamlining workflow and operations. Ensured that all work performed is in compliance with federal and state insurance
regulations.
Analyzing financial data reports and adhoc reports, monthly accounts receivable reporting, insurance denial analysis
reports and capital budget reports. Compiled monthly reports and analyzed statistics to identify patient satisfaction, clinical
operations and reimbursement trends.
Benefits Quality Assurance Manager and Trainer
Emergency Medical Physicians, Canton Ohio April 2005 to
November 2007
Managing, leading and training within the Medical Billing and Financial Services (MBFS
Responsible for project management including; benefits, HIPAA staff testing and training, software implementation and
relocating California office staff throughout facility.
Leading auditing staff through coaching philosophy.
Providing business requirements to technical team for staff training and testing.
Responsible for writing policies and procedure online manual for training and daily operations.
Health Benefits Coordinator / Reinsurance Analyst
Aultman Health Foundation – TPA AultCare, Canton Ohio September 1998 to
April 2005
Overseeing self-funded plan implementation.
Tracking and analyzing large dollar medical claims accumulating toward stop-loss and aggregate limits
according to contractual agreements.
Negotiating with insurance carrier representatives and underwriters for client renewals and procurements.
Managing vender implementation and day-to-day issues with client.
PROFESSIONAL ACCOMPLISHMENT
• 2011 Speaker at Ohio 6th Annual Wellness Conference, Columbus Ohio
• Mayor’s Proclamation Honoring Instructor of Students of Malone University Health Services
Management Program
Linda McBride
• Ecollege EDU 101B eCertification: Teaching Online Courses
• International Business Studies Rome American Hospital, Rome Italy
EDUCATION & CREDENTIALS
MBA - Walsh University (08/20/2006 - 08/01/2007)
North Canton, Ohio
Degree: MBA-Major: Master Degree; Minor: Health Administration
GPA: 3.8 Semester Hours: 24
Malone (01/01/2004 - 05/30/2006)
Canton, Ohio
United States
Degree: Bachelor of Science-Major: Management; Minor: Human Resource;
GPA: 3.8 Semester Hours: 24
Stark State College of Technology (01/01/1995 - 05/30/1998)
North Canton, Ohio
United States
Degree: Associates-Major: Accounting
GPA: 3.5 Semester Hours: 24
TECHNICAL SKILLS
Microsoft Office Products including Word, Excel, Access and PowerPoint, Lotus Notes, QuickBooks, Intuit
Tax, Practice Management Systems including RIMS, IDX, Onbase, NextGen and Medical Present Value,
Phynance. Experience with Oracle, SAP People Soft, SQL, Citrix Servers and Banner Database for City of
Canton.
PROFESSIONAL ASSOCIATIONS
Employers Healthcare Coalition, Ohio Healthcare Coalition
International Foundation of Employee Benefit Plans
Medical Group Management Association (MGMA)
Healthcare Financial Management Association (HFMA)
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