Professional Objective

Career Achievements

Recognizes people as the most important asset to any business/call center unit; Advocates nurturing and developing individuals for maximum potential

Increased average speed of answer rate from 85% to 97% by redesigning more efficient workflow procedures

Increased call resolution rate on initial contact from 75% to 98%

Developed and implemented professional call center procedures, which provided stellar customer service

Professional Experience

Quality Assurance Analyst, LASHGROUP, October 2017 to Present

Complete a full audit of a minimum of three incoming/outgoing for a team of Reimbursement Counselors to ensure team is in full compliance and is meeting service level agreements.

Complete and publish monthly quality reports for management team.

Complete all monthly coaching efforts with Reimbursement Counselors.

Assistant Manager, Reimbursement, LASHGROUP, April 2015 to October, 2017 Rockville, MD Ensured a minimum of 98% compliance of all Service Level Agreements for Client

Maintained less than a one day turnaround time for all Client service requests to include but not limited to benefit investigations, prior authorizations and appeals.

Managed a team of 15-23 Agents, Patient Care Coordinators and Team Leads.

Developed all department metrics, SOP’s and training materials.

Responsible for hiring, training and evaluating all team associates.

Identifies client issues and provides timely resolution.

Attends regular client meetings by phone and quarterly in person.

SR Reimbursement Consultant, LASHGROUP, Rockville, MD December 2011 to April, 2015

Completes a full, extensive medical and pharmaceutical insurance investigation for complex therapies for all commercial, public and government plans.

Collaborate with insurance companies, third party payers and client Case Managers to determine the most appropriate care for patients with special needs. Provide continuous support to Case Manager managing the patient and follow up with all parties to ensure no interruption in therapy arises.

Receive, triage and place orders to distributor as needed for fulfillment.

Execute wholesale agreements with customers who wish to purchase wholesale products. Determine proposal as per policy and execute with Legal Department’s guidance. Follow through until full execution.

SR Reimbursement Specialist, Cystic Fibrosis Services, Bethesda Md, March 2011-September 2011

Provide excellent Customer Service to internal and external customers by servicing pharmacy referrals faxed to call center within a two-day turnaround time.

Completed a thorough insurance verification prior to submitting prescriptions to the pharmacy for fulfillment

Collaborates with four specialty pharmacies to provide ultimate customer satisfaction

Provide courteous and empathetic solutions to patient with special health needs

Claims Billing Manager, Financial Health Strategies, Gaithersburg, MD, May 2010-October 2010

Provided a host of comprehensive services for three key accounts within a portfolio that generated over $50M in annual revenues

Collaborated directly with the Vice President of Billing and Outsourcing Options with bottom line responsibility for the monitoring and reviewing billing issues for Healthcare clients

Reviewed client accounts to determine that accurate insurance was assigned and corrected accounts with erroneous information for medical/professional dental practices

Oversaw recurring reconciliations activities; updated financial spreadsheets; balanced AR/AP Ledgers/Reports and forwards report of financial gain/losses to clients

Claims Manager, Bravo Health, Baltimore MD, May 2008-Feburary 2010

Effectively collaborated with key departments to ensure hospital claims were paid within ten days for Medicare Advantage Plan in Baltimore, MD

Resolved escalated claim issues immediately to preserve customer relationships

Key member of project team for development and implementation of new healthcare system

Developed policies and procedures in accordance with CMS regulations

Manager of Business Operations, the Trizetto Group, Linthicum, MD, April 2007-April 2008

Developed a strategy to correct system configuration issues that improved client relations

Provided training to remote employees in India via the internet

Reduced the Provider Database Inventory by 60%

Served as part of the auditing team that was voted "Best Team" in the entire company based upon the delivery of consistently significant and "Out of The Box" work

Manager of Claims and Client Services, Wellpoint Health Network, Springfield, VA, October 2000-January 2007

Effectively motivated and developed Customer Service Reps to achieve Administration Corporate goals

Educated provider population in appropriate billing practices and procedures

Liaison between employee groups and providers for complex issue resolutions

To promote excellent service, developed and implemented service incentive awards

Developed and implemented QA program that improved overall quality of the department.

Associate Director, Claims Administration DC Chartered Health Plan Washington, DC September, 1996 – August, 2000

Responsible for overall operations of Claims and Customer Service operations for DC Medicaid HMO(

Authored and implemented all department SOPs and training materials

Recruited and trained all new personnel

Successfully implemented new claims payment system

Supervisor, Claims Department GWU Health Plan, Bethesda, MD April, 1995- September, 1996

Responsible for the overall operation of the Claims Department for Metro DC area HMO

Developed policies and procedures pertaining to the processing of managed care claims for DC Medicaid and commercial contracts.

Hired, trained and coached new personnel

Supervisor, Claims Administration Corporation, Rockville, MD August 1984- April, 1995

Supervised unit of 15 Claims Examiners and Auditor for government contract PPO plan

Responsible for the overall daily operation of the claims processing unit and inventory management

Developed and implemented stellar training program named “Model Office” Hired, trained and coached

Full MS Office Suite, FACETS, QNXT,Oracle, CSC, EClinical Works, Medical Manager, Patient Plus Claims Examiners and Auditors

Education and Specialized Training

Montgomery College, Medical Terminology I ⅈ Rockville, Md 1981-1982; 4.0 GPA

Interpersonal skills training, Winning in Customer Service, Change Management, Resolving conflict, Behavioral Interviewing, Salesforce, TheraCall, Power Index, Peoplesafe

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