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Manager Office

Greenbelt, MD
October 27, 2018

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**** ********* **. ● Bowie, Maryland 20721 ● 301-***-****


Perceptive, discerning Health Care professional offering more than ten years of management, supervisory and data analysis. Experienced in maintaining a system of proper reporting and follow-up investigation, analysis and filing of all liability claims that occur in the organization. Health care Management professional with extensive experience and ability to manage varied health Operational services. Exhibit knowledge of federal, state healthcare policies, protocols, practices and contractual guidelines/regulations as it relates to State and local Insurance plan, and Managed Care to ensure ongoing compliance. Strong analytical abilities to ensure accurate patient tracking and data reporting; adept client coordination services that promote positive morale among critical team members, including the patient's healthcare provider, and demonstrates effectiveness in striving toward excellence in executing business goals.


Managed an array of business teams successfully over ten years, including 30 people as a Sales Support Manager and six people as a Night Audit Supervisor; received Manager of the Year acclaim successively in 1995, 1996, 1997; and executed the corporate mission by working well with diverse departments.

Spearheaded the coordination of home-infusion teams for six years by handling each administrative function with aplomb as well as adherence to health and safety requirements: followed Joint Commission on Accreditation of Healthcare Organizations (JCAHO) guidelines for organization audits; abided by Occupational Safety and Health Administration (OSHA) regulations; and made certain that all the necessary products, equipment, and resources were available when clients returned to their domiciles.

Proven exceptional ability to manage processes related to the clients’ administration, report preparation, trend mentoring, resubmissions and provider dispute resolutions.

Experience collaborating with internal resources to develop strategies that meet department goals within budget and established timelines.

Experience in identifying operational issues and recommending and implementing strategies to resolve problems.

Addresses and resolves enrollment/contribution issues with providers and tracks/monitors trends.

Researchers program enhancements and coordinates with Payroll and IT for implementation.

Actively researched and analyzed systems and processes that span across multiple operational areas.

Worked successfully with interdisciplinary teams by identifying problem areas, assessing alternative solutions, and resolving issues through diplomatic intervention.


Reconciliation Report

Data Reports and Documentation

Strong Analytical Skills

Corporate Guidelines

Confidential Records Management


Billing Practice

Claims Handling and Investigations

Proficient Data Entry Skills

OSHA Guidelines

Patient Coordination of Care

Keen Organizational Skills

Managed Care

Data Tracking/Verifications

Customer Service

Invoice Screening/Tracking

Billing Verifications

Interpersonal Relations

JCAHO Certifications


Able to work independently

Organization Compliance

Policy Interpretation

Oral/Written Communications


Option Care, Columbia, Maryland, 2008-2017

Reimbursement and Billing Analyst

Participates in special research and analytical projects related to Contract Billing, AR & Revenue Recognition department.

Provide analysis if cost incurred in accordance with contractual, company and federal guideline to determine billable costs and required supporting documentation for the process within I-Emphsys, Emdeon or EDI system.

Manage the accurate and processing of invoice. Investigate documents of secondary and third-party providers bills to determine reimbursement. Serve as the office liaison for all claims, billing and updates to company’s contract and audits.

Submit electronic billing invoices to ensure timely payment, resolve complex billing issues in an organized and systematic manner: investigate issues including mistakenly billed invoice / claims; work effectively with numerous operational areas and provider contracts;

Direct all phases of claim services including billing, coding, account follow up, claim denials, adjustments and communication of complex patient and insurance inquiries.

Work well with network clients, review organization plans regularly to manage customers’ expectations, communicated risks and status updates, and ensure that open issues were fully resolved.

Run and review daily exception reports, DSO reports, Revenue cycle reports (monthly), Credit-Rebill report (monthly) and follow-up on unpaid claim and Outstanding adjustment over 30 days.

Perform invoice trends and analysis to ensure that high dollar billing and adjustments have supporting documentation; and provide audits support for internal and external reporting requirements.

Assist in planning and implement reimbursement strategies which maximize revenue and efficiency.

Serve as the office liaison for all engagement of ongoing training of the branch to ensure compliance with existing procedural guidance that governs appeal adjudication.

Ensures all bills are current and invoicing documents conform to required client contract standards, follow company guideline and aligned with US Government GAAP.

Option Care, Columbia, Maryland, 2004 - 2008

Billing and Revenue Cycle Representative

Assists with all tasks involving claims processing and submissions to improve revenue and working internally and externally to ensure timely and accurate payment processing, claim data, denial management, and fixing trends to improve revenue cycle process

Ran monthly aging report to identify accounts with late payment and lagging time; negotiated collection and settlement or write off of debt; worked with sales and late payees to collect amount of over $450 K monthly

Work with management in identifying, researching, and resolving issues which may have led to inaccurate or untimely filing of claims, claim rejections, and/or other billing and collections issues.

Collected and analyzed data from various systems using pivot table and vlookup; ran monthly financial reports to identify unapplied cash and credits and allocated money to outstanding invoice.

Responsible for conducting audits to identify any claims trends, deficiencies, or performances issues in accordance with established protocols and fix any identified issues.

Works to ensure all tasks performed are done in compliance with billing policies and Medicare, Medicaid, and other federal and local regulations, rules, and laws, and contract requirements.

Assist in developing and implementing policies and procedures for submitting clean claims and receiving payments.

Assist in planning and implement reimbursement strategies which maximize revenue and efficiency.

Serve as the office liaison for all engagement of ongoing training of the branch to ensure compliance with existing procedural guidance that governs appeal adjudication.

Works independently while conducting reviews of revenue cycle processes, both intra and inter departmental, to determine workflow deficiencies and root cause.

Develops, recommends, and leads projects that drive process improvements that related to revenue cycle issues.

Podiatry Specialist, Rockville, Maryland, 2002 – 2004

Office Manager

Maintained an efficient office through thoughtful organizing and effective planning: maintained inventory, ordered supplies as needed, established a logical filing system, and made necessary adjustments that ensured smooth office operations.

Implemented the client billing system and handled all associated bookkeeping functions with 100% accuracy.

Handled day-to-day tasks successfully by communicating clearly, demonstrating leadership, and resolving issues in a professional manner.

Executed administrative duties flawlessly: word processing, office reception, training and managing staff, and conducting routine meetings.

Volunteer Experience

Joseline Pena-Melnyk Congressional Campaign, Laurel, MD 2015-2016

Seniors Campaign Coordinator

Organize fundraising to help the campaign accomplish its financial goal.

Work with specific constituency groups such as seniors, Educators, and the faith-based community to organize their involvement with the campaign.

Help develop a voter contact plan in coordination with the field director for particular communities by building relationships with the organization that represent these communities.

Assist with developing a comprehensive plan that includes door knocking and phoning in order to ID votes and persuade them about the candidate.

Assist with the coordination of voter registration efforts.

Coordinate the GOTV effort.

Support Large event logistics, advance, and turnout

Assist with other office and administrative tasks as assigned

Assist with social media content for the candidate pages


University of Maryland University College (UMUC), Adelphi, MD.

Master of Science: Business Administration and Technology. Expected Completion, December 2019.

University of Maryland University College, Adelphi, MD, 2011

B.S.: Management Studies.

Prince George's Community College, Largo, MD. 2008

Associate's Art: Fine Arts


I-Emphasis, MS Excel, MS Word, MS PowerPoint, Microsoft Project, EDI, EPIC, SharePoint, COGNOS, SAP, People Soft

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