LOVIE GRAYSON RICE

E: adrzq4@r.postjobfree.com M: 256-***-**** Huntsville, AL 35811

PROFESSIONAL SUMMARY

Results-driven professional with a Master’s degree in Business Administration coupled with diverse experience in various healthcare and regulatory environments. Highly analytical with a demonstrated success in evaluating high volumes of data, including contracts to ensure compliance with rules and regulations. Proven history of maximizing healthcare reimbursement goals through advanced research and claims analysis experience coupled with knowledge of insurance industry practices. Well-versed in creating deliverables, including spreadsheets and reports that outline performance and productivity indicators. Technologically proficient in various systems/software.

● Database Management

● Contract Analysis

● Revenue Cycle

● Compliance/Auditing

● Data Collection

● Report Preparation

PROFESSIONAL EXPERIENCE

Huntsville Hospital Health Systems – North Alabama Huntsville, AL Contracts Analyst/Collector 05/2021 – Current

● Successfully support the compliance, revenue, and reimbursement goals of the hospital by managing the claims recovery phase of the healthcare revenue cycle including healthcare analytics, DRG, HCPCS, CPT and ICD10 codes with a focus on contract analysis and appeals processing for various insurance payors.

● Independently evaluate complex medical claims of up to $1.1M in value for a high-volume surgery facility; proactively minimize revenue loss by reviewing hundreds of accounts per month to identify errors through research/contract interpretation efforts.

● Strategically analyze 30+ unpaid medical claims per day to develop an appeals strategy based on denial reason(s) and specific payor guidelines, including validating medical necessity, verifying the accuracy and of diagnosis codes, and services provided.

● Prioritize operational efficiency by leading the establishment of the patient portals for outpatient provider services with the Veteran Administration Community Care Network (VACCN), which has resulted in reduced claims errors and payment issues.

● Strengthened operational oversight of important key performance indicators by managing various spreadsheets to report on claims volume, claims status, recoupment rates, and trending errors, allowing leadership to make data-driven decisions. Huntsville Hospital Health Systems – North Alabama Huntsville, AL Precertification Representative 03/2016 – 05/2021

● Effectively contribute to the claim authorization and reimbursement goals of the cardiology department by managing the precertification process for 20+ cardiac and radiological procedures per day, ranging from $400 to $875K per procedure.

● Strategically supported 70+ providers in minimizing the risk of insurance denials by reviewing medical records (clinical notes, test/procedural results) to provide insurance payors with specific CPT and ICD-10 codes to determine medical necessity.

● Proactively cross-departmentally collaborated with clinical staff to keep stakeholders abreast of procedure authorization status/issues with upcoming appointments, with a focus on rescheduling unauthorized appointments to avoid revenue loss.

● Prioritize new hire training efforts by contributing to the development of job aids, tip sheets, and insurance resources while leading hands-on training regarding insurance payor guidelines, software navigation, and authorization best practices. Saputo Dairy Decatur, AL

contract Quality Assurance Technician 11/2015 – 01/2016

● Effectively supported the operational, quality assurance, and compliance goals of the dairy company by managing the inspection, verification, testing, reporting, and certification processes for more than 40 dairy product types.

● Independently prepared and processed samples for analytical testing while adhering to specific processing guidelines/timelines; tested reported weights, measurements, color, texture, temperature, and packaging requirements.

● Proactively evaluated sample requests for accuracy and suitability for analysis while communicating with stakeholders

(Quality Assurance Manager, Laboratory lead) to explain issues that may impact the quality or accuracy of the sample results.

Kroger Co. Huntsville, AL

Certified Pharmacy Technician 05/2014 – 02/2018

● Independently calculated dosages, dispensed medications, prepared prescription labels, and filled approximately 400 prescriptions/week for approval by pharmacists while utilizing the pharmacy management system to document all actions.

● Maximized inventory control practices through weekly monitoring, with a focus on ensuring the accuracy and completeness of required logs and reports; strategically implemented a first in, first out practice which reduced pill expiration loss by 5%.

● Proactively evaluated pharmacy operations to ensure compliance with FDA, DEA, and EPA regulations by auditing and inspecting logs, patient files, inventory records, storage/ordering practices, resulting in successful pass rates during audits.

● Maintained inbound and outbound communication via email and phone from providers and insurance payors while assisting the pharmacist in maintaining oversight of pharmacy inspections, audits, re-certifications, and insurance enrollments.

Aerotek – Harcros Chemicals Inc Chattanooga, TN

contract Process Chemist/Quality Analyst 11/2013 – 01/2014

● Successfully performed various analytical tests while following regulatory and federal regulations for an average of 20 tests per day, with a focus on safety, accuracy, and quality assurance.

● Maintained accurate records of test results on standardized forms and wrote test reports, including specific data such as the instrument ID, weights used in analysis, date, time, calculations, temperatures, final results, and initials.

● Independently tested product stability on samples for large-scale production; performed testing based on the product

(color, temperature, High-Performance Liquid Chromatography (HPLC), Gas Chromatography) within established timelines.

● Executed the identification of impurities and processed experiments on agricultural products; collated information to process specific reports for batches to be reworked while supporting an average final product turnover of 8 railcars/week. Battelle Memorial Institute Anniston, AL

Data Analyst/Lab Tech 09/2011 – 08/2013

● Strategically supported the EPA and Alabama’s Department of Environmental Management in implementing quality control and quality assurance control measures related to the destruction of chemical munitions through analytical testing.

● Independently analyzed environmental Demilitarization Area Air Monitoring System (DAAMS) solid sorbent tube samples to verify destruction of military munitions filled with deadly gases contracted through Department of Defense (DoD).

● Performed moderately complex mathematical calculations, data analysis, and data manipulations, and prepare data for study directors, principal analytical investigators, or project managers with a focus on accuracy and complete documentation.

● Independently performed analyses of environmental samples by Gas Chromatography (GC), GC/ Mass Spectrometry (MS), Liquid Chromatography (LC)/MS, and/or LC-MS/MS.

EDUCATION

Master of Business Administration Certificate of Billing and Coding Bachelor of Science, Biochemistry Alabama A&M University – Huntsville, AL Calhoun Community College-Decatur, AL TN State University-Nashville, TN May 2020 Aug 2018 May 2001

PUBLICATIONS

“Quality Healthcare Improvement Projects Supporting Positive Change Behind CoVid-19” American Society of Quality Healthcare Division, the Healthcare Report volume I June 2021, pgs. 17,18

“Aryliocyanato Selective Androgen Receptor Modulators (SARMs) for Prostate Cancer” University of TN Health Science Center, National Institutes of Health post-fellowship research 2007 SOFTWARE/TECHNOLOGICAL PROFICIENCY

Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Access) Laboratory Information Management System (LIMS) HH EMR software, MedeAnalytics Software, JDA Parathon, HQ software, SSI Healthcare software, Cerner Healthcare software VOLUNTEER

-American Society of Quality (ASQ) volunteer (04/04/2019-Present)-participate in quarterly healthcare division meetings to discuss quality endeavors

-Project Coordinator (03/2020-05/2021) HH Heart Center-managed activities to accrue funds for essential workers during pandemic

-Graduate Representative (09/24-28/2019) AL A&M University-represent university during national academic meeting in Houston, TX

-Court Appointed Juvenile Advocate volunteer (CAJA) (09/2014-Present) Madison County, AL-volunteer at fundraising activities

-Tennessee State University alumni (6/2001-Present)-mentor and support students and collegiate activities for university

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