Quality Assurance Manager
Resume:
ANA BARRERA
P: 847-***-**** LinkedIn: http://linkedin.com/in/ana-barrera-856857b6 Grayslake, IL
PROFESSIONAL PROFILE
Innovative and driven professional with extensive experience in implementing regulatory requirements in a dynamic environment. Meticulous with details and strong understanding of methods to troubleshoot any problem, identify root cause, and implement resolution and follow through to successful closure. Collaborative style to lead and motivate cross-functional planning and coordinating projects, adapting to changes in priorities and schedules, setting vision and strategies to build and deliver results with integrity. TECHNICAL SKILLS
Inventory Program Implementation Project Management Proficient in MS Office
Quality Program Implementation Strong Communication Skills Basic ICD-9/CPT/HCPCS Coding
Effective Problem/Conflict Resolution Continuous Improvement Health Care Fraud Investigators PROFESSIONAL EXPERIENCE
CHANGE HEALTHCARE Lombard, IL
MULTI-DISCIPLINARY COMPLIANCE OPERATIONS SUPERVISOR June 2018 – Present
Responsible for development and implementation of quality and inventory systems; developing and managing multi-disciplinary teams to ensure process workflows are executed, compliant with internal procedures and industry regulations, and processed in a timely manner. Currently managing the following teams:
The Quality Assurance team to review and audit various processes within the organization. Also responsible for providing training the staff involved in the audit and remediation process. Implemented and created a new Quality Assurance Program for a staff of 45, encompassing 63 Quality Audit Templates, while housing all templates and tracking documents in new SharePoint site designed for internal Auditors to utilize with ease
The Inventory Management team to ensure that team meets daily, weekly, monthly pushes on a specific subset of inventory at risk, with potential, or revenue driven which requires resolution.
The Appeal Team to identify and process all appeals that are submitted through the electronic system. Appeals workflow include appeal level assignment, prioritization and expedition of appeals based on case status and service line.
Lead in the development and implementation of quality and inventory systems.
Develop and implement internal metrics to serve as an effectiveness check for the monitoring of enhanced workflow processes.
CLIENT SUPPORT TEAM OPERATIONS SUPERVISOR
December 2017 – June 2018
Responsible for managing multiple client payment verification inventories. Clients included Aetna, Affinity, Anthem/Empire, BCBS-AZ, BCBS-VT, BCBS-MN, BCBS-ID, Caremore, CCStpa, California Prisons, HealthNow, WellMed, Molina, Cigna Healthcare, Cigna West, Cigna AZ, HCSC, BCI.
Managed multi-person team in the day-to-day and long term strategic plan execution related to the processing and maintaining various client payment inventories.
Assessed and streamlined payment verification workflows to ensure payments were promptly and accurately processed.
Reconciled and closed-out of aged inventory and end-of-month processes were completed successfully.
PRODUCT OPERATION COORDINATOR – QA TEAM – INTERNAL PROCESS AUDITOR May 2015 – December 2017
Responsible for the enhancement and maintenance of the inventory management system and workflows. Developed and submitted Quarterly Closure report to upper management.
Conducted random internal audits conducted of the Inventory Management of DRG inventory. Identified and obsolete workflow steps that resulted in the reduction by excessive inventory by10%.
Created and updated standard operating procedures, manuals, and forms (upwards of 250 documents) across multiple departments.
ANA BARRERA
P: 847-***-**** LinkedIn: http://linkedin.com/in/ana-barrera-856857b6 Grayslake, IL
Developed ongoing process improvement plan for the monitoring and management of operational email boxes, live call sessions, and educational tools for employees.
Developed and implemented internal metrics to serve as an effectiveness check for the monitoring of enhanced workflow processes.
ANA BARRERA
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EQUICLAIM Naperville, IL
HOSPITAL CHARGE AUDIT SCREENER
July 2013 – May 2015
Responsible for enhancing and assuring compliance to multiple client’s guidelines and screening processes and reducing HCA open inventory by 35%.
Developed and maintained a constant strong rapport with auditors and audit coordinators during the enhancement of data review process. Lead the collaboration of these team members in the enhancement of data review from manual to automated reviews.
Audited and identified data driven trends as defined in DX Codes, Revenue Codes, and provider behavior.
Created and implemented manual/training documentation for HCA Screener position.
Successfully executed screening process training to registered nurses. SENTINEL GROUP Lincolnshire, IL
TRIAGE INVESTIGATIVE ASSISTANT
July 2011 – July 2013
Responsible for the audit of domestic and off-shore triaged claims for accuracy and handle the completion of the medical records request process.
Served as the primary claims contact for off-shore operations.
Processed a triage caseload of approximately 100 claims daily with an average audit score of 99.85% accuracy.
Reviewed and validated incoming claims to ensure compliance with client guidelines and identified claims requiring for investigation.
Reviewed and analyzed historical data and provided to the analytics department that identified low revenue bearing cases.
Participated in system enhancement testing project, creation of new case plans, and creation/implementation of related training documentation. PROFESSIONAL AFFILIATIONS
Appointed Delegate of the Young Professionals Making Change Business Resource Group
Payment Integrity Engagement Business Resource Group
20th Annual AAMAS Conference – 2014
Appointed Administrative Team department Career Fair Speaker – 2017 EDUCATION
WESTERN ILLINOIS UNIVERSITY, Macomb, IL May 2011
Bachelor of Science in Law Enforcement and Justice Administration, Minor in Psychology
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