Quality Assurance Management
Resume:
KARENLEE HERRON, EFPM, CAPPM
Bahama, NC 27503
**********@*****.***
Accomplished Operations Manager with extensive experience in project management of large scale multimillion dollar research surveys, including data entry, call center, staffing and medical coding is looking to bring enthusiasm, energy and passion to a management position with an established company with a cutting edge mentality. Dedicated and personable with a talent for maximizing efficiency and exceptional quality while maintaining high output, meeting urgent deadlines, providing staff mentoring and motivation while meeting and exceeding client requirements. Has a proven ability to maintain composure, sense of humor and professionalism during crisis while excelling in client success, team building, staff mentoring and management.
Summary of Qualifications
Operations Management
Quality Assurance
oData Entry
oICD-9-CM/Vol 3
oICD-10-CM/PCS
oStatistical Coding
oValidation and Export Review
Physician’s Practice Management
Academic Practice Management
Client Success
Project Management
Staff Development
Staffing
Team Building
Inventory Management
Strengths
Operations / Project Management: Enthusiastic project manager with the ability to interpret and achieve project scope. Clearly communicates with colleagues of all career levels, proven ability to act as a liaison between different personality types and departments while maintaining corporate values.
Client Success: Over 20 years of direct client collaboration experience, with proven ability to deliver key project milestones with exceptional quality, under urgent deadlines. Serves as technical lead and historian for clients while assessing gaps in the assumptions, scope of work (SOW), service level agreements (SLA) and provides feedback on executive roadmap decisions.
Staff Development: Trusted team builder who understands process dynamics necessary to build creative teams with common purpose while capitalizing on different team players work styles and producing measurable results.
Survey’s, Software Development, Contracts, and Grants: The lead resource of cross-functional survey development, with extensive experience in survey abstraction, application development, design, and coordination with information technology engineers. Acts as the facilitator for client kick-off meeting, monthly client meetings and the auditing of quality assurance teams. Technical resource for the contract/proposal writing team in response to survey proposals (RFP).
Other: Emphatic listener who applies critical thinking to overcome operational challenges. Creatively uses time and resources effectively; considers efficiency, planning, transparency, and accountability very important.
Work Experience
SRA International, Durham, NC October 18, 2004–Present
Data Services Operations Manager: Manages and coordinates the operations of the Data Services department engaged in multiple medical coding, statistical coding and data abstraction projects at multiple sites. Project management responsibilities include integrating new projects to adhere to the scope of work, service level agreements, day to day staffing activities and quality assurance, validation, and exportation review prior to the close-out of completed projects. Also assists the Program Director with financial and operational oversight on various projects, the application of project management methodology, staff management and development, and execution of the quality assurance and training plans. Serves as project manager, when necessary while supporting the growth of the business through various business development activities, including proposal preparation and budget forecasting, all while maintaining client success. Provides support for execution of the annual divisional business plan and budget.
Oversees and manages the Quality Assurance team on the processing and training functions for multiple projects to include the National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, National Hospital Discharge Survey, National Ambulatory Surgery Centers, National Electronic Health Records Survey, National Ambulatory Medical Care Survey Supplement on Culturally and Linguistically Appropriate Services, National Health Interview Survey (Insurance and Injury), National Consumer Protection Commission, North American Industry Classification System, and Standard Occupational Classification System.
Participates and attends the ICD-10-CM Coordination and Maintenance Committee meetings through the Department of Health and Human Services bi-yearly.
The University of North Carolina at Chapel Hill, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Chapel Hill, NC, September 4, 2000–April 30, 2005
Administrative Officer II: Pulmonary and Critical Care Medicine: The Division Administrator directs all of the business operations of the Division of Pulmonary and Critical Care Medicine. The Division of Pulmonary and Critical Care Medicine is one of the larger and more complex divisions in the Department of Medicine. The Division's total budget exceeds $8.40 million and its personnel count is 97 (temporary staff are not included in this figure). The Division's personnel generate clinical charges in excess of $6.2 million annually. As such, it has overall responsibility for administration, financial planning/allocation of resources, human resource management, facilities/space management, and program and policies planning, development and implementation. This position reports directly to the Division Chief and has the extensive authority and responsibility to decide and implement strategies, programs, and policies that will commit the Division to courses of action that have financial and other implications for Division operations. This position represents the Division Chief in high-level meetings and negotiations both on and off campus.
Breakdown: Divisional budgets, Clinical budgets, Contracts and grants budget forecasting, hiring temporary employees, creating new permanent Exempt Personnel Act (EPA) State Personnel Act (SPA) positions, re-describing existing permanent positions, in-range salary increase, recruiting of new EPA employees, salary source designation/changes, pulmonary staff and faculty Project Accounting and Review system (PARS), development of work plans and work distribution, review and develop a plan for monitoring and increasing clinical income, development of transcription services under best practice measures, pulmonary division Faculty Effort Reporting System (FERS), promotions of faculty in conjunction with EPA coordinator, re-appointments in Conjunction with the EPA coordinator, tracking of the BD119 forms, reporting to Department Chief of medicine, physician credentialing in conjunction with the EPA coordinator
Accomplishments in this role: Develop and maintain a monthly monitoring system to track contracts and grants expenses, to include budget, actuals, encumbrances and future forecasting. Develop a monthly account reporting system for primary investigators. Investigate, recover and correct negative grant balances (negative accounts exceeded $120,000) from 1998, 1999, 2000 attributing to the profitability of the division. Help to expedite the transition from manual dictation system to voice activated/natural language software (E-scription). Establish employee records and production reporting for faculty clinical income, transitioning the group to an academic, research and clinical production based salary system.
Glendale Clinic / Columbia – St. Mary’s Physician Division, Milwaukee, WI, January 2, 1992 – Sept 1, 2000
Clinic Material Support Coordinator: Develop and maintain materials and purchasing system for 27 clinics within the Columbia- ST. Mary's Physician Division. Coordinate and oversee a stockless system within the organization with less than a 2% error rate. Overall saving during the last six months was $750,000. Train clinical staff on application and use of the purchasing computer system and develop training materials. Responsibilities include scheduling of physicians and staff, managerial and financial reporting.
Other responsibilities: Accounts receivable and payable, lead resource for problem accounts when all other resources had been exhausted, review of clinical equipment, standardization of supplies, clinic asset management, liaison between hospital purchasing, accounting, information systems, and materials distribution, extensive knowledge of physician credentialing, major insurance plans, including HMO, PPO, and POS contracts, liaison to business office regarding expertise in CPT and ICD-9 coding issues (held Coding Certification in Wisconsin until September 2000), auditing of medical ledgers, medical records, and clinical equipment (past narcotic auditor, held Pharmacy Tech certificate until 1988), liaison between health care providers, patients, and other ancillary services
Accomplishments in this role: Crisis management. Refurbish a 10,000 square foot clinic devastated by flooding in 1997 within a three-week time frame. Responsibilities included working with construction contractors, insurance carriers, and FEMA to recover loss of building and equipment. Worked exclusively with General Electric to locate and install new Lunar radiology equipment. This project resulted in the recovery of over $250,000 of equipment and building losses.
Develop standardized products; maintain training materials and purchasing system for 27 clinics within the Columbia-St. Mary's Physician Division. Coordinated and oversaw the stockless system within the organization with less than a 2% error rate. Develop protocols for ordering. Create and develop standardized forms for the 27 clinics within the Columbia-St. Mary’s Physician Division. Contract with product vendors, establish stockless systems for standardized forms where available, develop and create protocols for form usage.
Committees:
Forms Standardization Committee, Committee Chair
Product Value Analysis Committee, Committee Member
Clinic Infectious Control Committee, Committee Member
GI/GU Standardization Committee, Committee Member
St Michael's Doctors Association, Milwaukee, WI, April 1990 – December 31, 1991
Supervisor Claims and Members Services: Supervise and manage HMO Insurance claims adjudication, process and disbursement provider claims payment, and abstraction of physician and hospital medical records for claims auditing. Supervise member services and provider contracting. Train staff on ICD-9-CM/CPT-4 application and review, scheduling of medical coders and supervision of claims membership/call center staff. Responsibilities included the coordination of physicians contracting, credentialing, hospital boarding, membership and customer success.
OB/GYN Medical Services, Inc. Milwaukee, WI, April 1988 – April 1990
Insurance Billing Specialist: ICD-9-CM and CPT-4 coding claims review and claims submission. Review of monthly billing statements sent to the patient base and all tasks associated with accounts receivable. Responsibilities included insurance carrier contracting, customer success, physician hospital boarding and credentialing.
Bohn's Grand Avenue Pharmacy, Milwaukee, WI, December 1986 – April 1988
Manager- Pharmacy Technician: Manager of Pharmacy staff. Responsibilities included scheduling of Pharmacists, review of monthly billing to insurance carriers, accounts payable and receivable. Pharmacy Technician responsibilities included compounding of prescriptions, regulatory paperwork, and auditing.
Froedtert Memorial Lutheran Hospital, Wauwatosa, WI, May 1983 – December 1986
Pharmacy Technician/ Pharmacy Billing: Responsibilities included Inpatient pharmacy billing, compounding of prescription drugs from dry materials into the intravenous vein (IV's) and narcotic and medication auditing.
Education
NIDA Clinical Trials Network, Good Clinical Practices, Certification - October 26, 2016 – October 26, 2019
Associate Degree in Business, Strayer University, Global Campus - April 2009-2013 4.0 GPA, Deans Honor Society
Administrator of Physician Practice Management- National Certification July 2002 to present (32-36 CEU’s bi-yearly)
Fellowship in Physician Practice Management- Awarded- June 2002
Blue Mountain Training Solutions, Landscape Design Certification Program – September 2016- present
State of Wisconsin Medical Society, Certification in ICD-9-CM and CPT (CCS and CCS-P) 1988-2000
State of Wisconsin Medical Society, Medicare Advanced coding 1988-2000
State of Wisconsin Medical Society, Medicare Policies and Procedures 1988-2000
State of Wisconsin Medical Society, Health Insurance Claims Processing 1991-2000
Milwaukee Area Technical College, SCORE – Small Business Certification – October 1992
Professional Organizations
Member of AHIMA – American Health Information Management Association – 2004 to Present
Member of AHA- American Hospital Association – 2000 to present
American Academy of Medical Management 2000 to Present
Medical Group Management Association 2004 to 2005
North Carolina Society of Research Administrators 2002 to 2007
State of Wisconsin Medical Society 1988-2000
Selected Presentations
Presenter- Centers for Disease Control, Census Bureau Abstractor and Supervisors Training, Washington, DC and Atlanta, GA- July 2008
Presenter – North Carolina Health Information Management Association, Raleigh Chapter, Wake Medical Center, Raleigh, NC- April 2004- Coding in the National Health Survey
Facilitator- Pfizer Pharmaceuticals, COPD Preceptorship Conference, Chapel Hill, NC- April 2004
Facilitator- AstraZeneca’s First Annual Researchers Forum, Washington DC – October 2004
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