Manager Quality Control
Resume:
RACHELLE LOVE
********@*******.***
ARLINGTON, TX 76010 3220
OBJECTIVE:
Health Care Industry Objective to obtain a position that reflects my skills while actively utilizing my
proficiency in software applications and systems within the Health Care Industry. Results driven business
professional with 10 years’ experience in Health Care Industry which includes strategic planning.
Successful in managing the process of healthcare accounts for daily operations and customer inquiries,
while adhering to quality individual/unit goals and productivity. Solid experience in monitoring healthcare
accounts according to contract guidelines. Proven experienced in implementing new processes that
enhance business partnerships, and improved quality control. I am a motivated individual who is flexible,
adaptable and dependable with excellent effective communication skills that places emphasis on building
strong client relationships. I am looking forward to branching out into a new career in the IT field. I also
work well in a diverse team environment.
EDUCATION
Phoenix University, Phoenix, AZ – IT Technology Bachelor of Science Degree Business Systems Analyst
Baltimore City Community College (BCCC) Baltimore, MD – A.A.S. Degree PC Application Specialist
TECHNICAL QUALIFICATIONS:
Proficient with SQL, MS Access, Excel, Unix/Linux, Citrix applications Allscripts/Eclipsys, EHR
•
Work all 3M Citrix environments, Planview, BLN/HRWW, Lawson systems, Windows XP, ISS Rejects,
•
EMPI
• Outstanding communication and organizational skills with project planning and implementation
• Strong Analytical & Problem Solving Skills
Professional Experience
IS Application Analyst 12/2012 Present
Baylor Healthcare
Dallas, TX
• Receive all Tier 1 5 Heat tickets and resolve issues in accordance with BIS Service Level Agreements identify and
escalate complex Application IS issues to the application manager. Effectively communicate with non technical
users to resolve problems and errors in the system application.
• Manage and maintains data integrity for Citrix based environments including adding and removing users, resolving
password issues and maintaining/updating user credentials specific to location changes for multiple IS systems
(clinical and/or operations).
• Troubleshoot problems, implements changes to resolve issues and document findings.
• Updates to master files/tables through merges in physician accounts, routine additions to master files, and other
related activities.
• Provide accurate and up to date system, site, and project documentation.
• Monitors work progress, informing team leaders, managers, and/or customers of project status, issues, or
obstacles in a timely manner.
• Manages data integrity through assisting with patient merges, moves and discharges, and resolving interface
errors.
• Identifies system events by monitoring the event log and identifying and escalating activity patterns, compiling and
distributing daily reports and managing the data archival process.
Manage end user training results by directing end users to the appropriate training resources.
• Provisioning users and adding, deactivating, deleting, and reactivating accounts in Lawson
Government Appeals Assistant 4/2009 12/07/2012
Baylor Healthcare
Dallas, TX
• Utilize and update Patcom, Stat, Quic, Midas, and Web, Xclaim, and Eclipses systems for research of patient
accounts.
• Manipulate Data in Midas systems to retrieve patient accounting information
• Develop queries and reports in Midas and Stat systems
• Request debit and credit adjustments to balance account totals and zero account balance.
• Request Medical records and write first and second level appeals and submit via certified mail.
• Prepare spreadsheet for denied or upheld appeals for claims review meeting scheduled once a month to
discuss if claims should be closed or if second level appeal should be initiated. All cases are discussed with
Contract Compliance Manager and Director along with Denial Resources Center (DRC) Director
• Organize staff meetings for the DRC to discuss upheld or denied accounts with our Medicaid
Representative once a month. I also take and distribute the minutes after the meeting.
Medical Collector Assistant 12/02/2002 04/2009
Baylor Healthcare
Dallas, TX
• Check claim status via Medicare Florida Share System (FSS) and via phone.
• Verify patient insurance coverage and benefits via internet (FSS) and phone.
• Request debit and credit adjustments to balance account totals
• Submit UB92 and HCFA1500 claims to Medicare and Manage Care for payment via Xactimed clearinghouse.
• Request medical records to prepare appeals for various Medicare/Managed Care denials
• Utilize Patcom, Stat/Quic and Meditech systems for research and to analyze patient accounts
• Research Explanation of Benefits (EOB) for accurate claim payment and verification of coinsurance and
deductible amounts
Achievements
Service Excellence Award 05/2010
01/2011
All Star Employee of the Month
Bill Aston Finance Award 10/2011
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