Manager Management

Lora Harrison

*** ***** ****** ******, *** Harbor, OH 43449

(Home) 419-***-**** (Cellular) 419-***-****

abnlio@r.postjobfree.com

Profile

A strong and solid background in managing employees, financial analysis, auditing and benchmarking, with an emphasis in

computer technology, implementation and training on the software applications. Consistently exceeds implementation

goals for the client, customer, organization and employee service expectations. Skilled in developing baselines and

implementing standardized policies, procedures, action plans and process improvement initiatives. Strong and proven track

record with teaching staff on software applications, policies, and motivational requirements related to job descriptions.

Experience

ACS/Buck Consultants, July 2008 – Current

Senior Consultant, Retiree Drug Subsidy, (CMS), Pharmacy Auditor and Clinical Analyst

Performs 100% electronic review of claims and conducts field audits in pharmacies and at other provider sites by traveling

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to provider-sites and examining source documents such as prescriptions, patient medical records, SPD’s, Administrative

Services Agreements, and contracts to determining and validated compliance and adherence to contract terms and source

documents.

Conducts pharmacy claims audits and Retiree Drug Subsidy audits in accordance with CMS, governmental and company

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audit guidelines. Assess financial accuracy of claims and processes including error, abuse and fraud detection.

Interviews clients, prospective clients, providers, employees, patient, families, physicians and witnesses regarding all

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aspects of audit, potential fraud schemes, goals, expectations and documents each interaction on interviews.

Document and support all findings with applicable citations in federal, state, plan rules and regulations according to

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standard operating procedures.

Preparation audits making sure the appropriate data samples are drawn, work papers are ready and the appropriate parties

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are notified. Conduct in-house audits, desk audits and electronic reviews of data to target aberrations or improvements.

Perform post-audit activities such as discrepancy validation and reconciliation. Generate and present final reports for the

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client with systemic, relative, and financial analysis with actions plans, recommendations and recoveries.

Compose, edit, validate and report audit findings. Provide documentation during negotiation proceedings and throughout

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the audit project. Participate in administrative hearings, client discussions and court proceedings. Utilizing project

management tools to keep the project timeline and objects on task.

Evaluate and conduct other audit and data analyses as required. Review the client’s role regarding administration and offer

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recommendation to data and claim information to management decisions.

Firelands Regional Medical Center August 2005 January 2008

Clinical Informatics Analyst

Implementation and management of several Clinical and Performance Improvement based software systems throughout

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the Acute Care hospital and ancillary departments. Software systems included, but are not limited to: Premier Clinical

Advisor, Quality Measures Reporter. System Manager of Midas plus Care Manager, Midas Seeker and Credentialing,

Midas Core Measure Reporter, Administrator of Q-Net reporting, McKesson InterQual documentation of Severity of Illness,

Intensity of Service. Created PAAD format files from Midas to facilitate data download to Premier Clinical Advisor.

Implementation tasks included analyzing existing data to increase hospital operation efficiency in the case management,

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utilization review, discharge placement, bed management, and clinical decision support departments as well as

implementing hospital wide managerial dashboards. Projects were conducted for the integration of existing systems to

share a seamless data transfer, eliminate duplication of documentation efforts, and to maximize workflow efficiency. Lean

practice initiatives were incorporated to facilitate the workflow process, employee expectations, and to help define the

project objectives and outcomes.

Benchmarking Hospital performance internally, externally through clinical and financial information. Analyzing, interpreting

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and reporting document usage for evidence based care diagnoses. Building reports with various applications upon request

for Director and Managerial personnel. Drilling down into reports and other application reports in deviant areas to assist

with root cause identification.

Teaching and training on multiple software applications as related to job duties and descriptions. Maintaining good rapport

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and cooperative relationships with employees, directors, physicians and management in helping to identify problems,

offering solutions, and participating in resolutions with action plans.

Rounded as a Case Manager for Family Practice group of Physicians with the desire to improve patient outcomes and

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resource management. Prioritizing patients, rounding with Physicians, verifying diagnostic testing, laboratory results and

highlighting any pertinent information necessary for the Physician in rendering his plan of care. Documentation of all care

plans in Midas for the Severity of Illness, and Intensity of Service for the acute, concurrent and discharge stays of the

patient. Facilitated all patient discharge plans and follow up appointments.

Provided technical and statistical support for Director of Case Management Department, Quality, and Risk, Patient Safety,

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Nursing, Physicians and all ancillary departments directly reporting to the management staff.

Identify, analyze, design, create, and implement processes of change needed for Hospital and departmental growth.

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Firelands Regional Medical Center February 2003-August 2005

Clinical Application Analyst

Supported the data reporting needs of the Quality Management, Risk, Patient Safety and Utilization Departments and

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Hospital management. Midas Plus system manager, Q-Net Administrator, Keypro Administrator, JACHO reporting

Administrator, Anthem and MMOH annual reporting. Facilitated all contacts with surveyors while on the Hospital premises.

Analyze, interpret, and report Quality data for Hospital and Governing bodies. Development and design of clinical reports

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and creation of standard and ad hoc clinical reports as needed to support regulatory requirements and or clinical

departments.

Downloads, uploads, and formats data from various databases for reports distributed throughout the organization. Building

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comparative reports and analyzing quality data for accuracy and for areas of opportunity for improvement in clinical

processes.

Resource liaison for interdisciplinary teams to promote collaboration and coordination of hospital wide workflow processes,

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educational needs and workflow solutions.

Performing medical record reviews as needed for performance improvement activities. Entering clinical chart review

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abstraction data into web based tools.

Management team leader and implementation analyst on patient and hospital workflow solutions, bed management

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systems, Meditech EMR, PCS, POE systems, clinical software systems ensuring the best possible outcomes for the

hospital, employee and patients.

Training current and new personnel on multiple software applications. Presenting all training and learning modules for all

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software applications according to job descriptions. Utilizing multiple on-line computer trainings and web applications for

training presentations allowing the users to learn and use the computer based applications while learning. The use of

power-point and smart-draw for flow charts giving the end users the ability to reference materials on the processes and help

the employee to identify their role in the processes.

Participated in presentations for Hospital staff, Managers, Directors, Board of Directors and Physicians.

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Firelands Regional Medical Center June 1993-February 2003

Pharmacy Technician

Under the direct supervision of a Registered Pharmacist and according to standard policies and procedures, compounds

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and remedies for dispensing medications and pharmacy supplies upon receiving orders from Physicians or other qualified

prescribe(r).

Aided in processing, filling and distributing Pharmaceuticals in Hospital environment.

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Processed patient charge records. Mixed IV additives, chemotherapy solutions as required using aseptic techniques with a

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laminar air flow hood.

Monitored usage, ordering, processing of Pharmacy Department.

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Implementation support for computer and technical developments in Pharmacy Department.

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Education

Associates Degree in Applied Business

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Associates Degree in Diversified Medical Occupations

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Certifications

Midas System Manger, Midas Core Measure Data Abstractor Certificates, Midas Seeker and Physician Credentialing System

Manager, Meditech, Order Entry, Physician Order Entry, Electronic Medical Record, Train the Trainer Certificates from

Premier Clinical Advisor, Meditech, Midas, McKesson InterQual, Premier Physician Reporting Benchmarks and Dashboards,

Ethics and Management Training, Class ”B” CDL.

Contact this candidate