Summary

Strong management and communication skills; a forward thinker with an aptitude for problem solving. Highly motivated and readiness to learn in a fast-paced work environment. Highly versatile skill set and range of experiences, which includes consulting clients include both local and large national self-insured health and welfare plans. A talent for analyzing problems and finding innovative solutions. Committed to the highest levels of professional and personal excellence.

Selected Skills and Accomplishments

Certified Health Insurance Portability and Accountability Act (HIPAA) Privacy Associate

Areas of Specialization

Healthcare Audits - Medical, Mental Health, Workers’ Compensation, Stop-Loss, Discounts and Fees

Administrative Services Only (ASO) Agreement Evaluation and Compliance

Extensive knowledge of CPT/HCPCS code, as well as ICD 9 and 10 codes

Employment Responsibilities

Senior Healthcare Consultant/Healthcare Claims Auditor

Successfully identifies financial and procedural findings in a selection of samples of healthcare claims and examine the samples to verify that the Third Party Administrator is following the Summary Plan Description established by our clients; these errors are discussed with the Third Party Administrator.

Analytically explore the financial findings found with the Third Party Administrator to calculate the total fiscal impact of the finding.

Constructs an Operational Review Report that documents all of the financial and procedural findings, observations, and suggestions at the end of an audit. This report is presented to the client and to the Third Party Administrator.

Trains newly hired employees.

Mediated cases on various healthcare complaints, while being sensitive to individual needs and concerns with great understanding and intuition in an emotionally difficult situations.

Aided consumers on their various healthcare/ health insurance questions on the Office of the Attorney General’s Health Advocacy Hotline.

Employment History

PBMares LLC Healthcare Consultant/ Analyst March 2014- April 2017

Medical Device Depot Orders/ Accounts Receivable May 2013-January 2014

Specialist

Office of the Attorney General: Health Advocacy Specialist Feb 2013 - May 2013

Health Advocacy Unit

Education

University of Maryland Baltimore County Bachelor of Arts

Health Administration and Public Policy Awarded December 2013

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