Support Specialist Medical Billing
Resume:
Rae Langston
Corporate Management and Creative Leadership
Contact
***********@*****.***
www.linkedin.com/in/rae-langston19148
Summary
Offering over 15 years of leadership experience in various roles including healthcare fraud, data management, and strategic/operational risk management. I specialize in program development and issue resolution, driving improvements through innovation and leadership.
Education
MBF Institute, 2022
Life Coach/Mind-Body Practitioner
Strayer University, 2007
Medical Billing/Coding Specialist
Healthcare Administration
Chubb Institute, 2000
Technical Support Specialist
Experience
2016-2022
Risk Management • ERM • AmeriHealth Caritas
Developed Enterprise Risk Management practices, tools, and policies to report, analyze, and manage enterprise risks.
Designed programs and protocols to identify, monitor and control risk exposure across 15 organizational lines of business in addition to all corporate functions.
Organized and managed results-oriented teams in program management, process improvement and development, as well as issue management to minimize loss and adverse financial impact.
Development and ownership of risk reporting including mitigation strategies to Senior Executives, C-Suite, Parent Companies and Board of Directors.
Development and delivery of educational documents on Risk Management framework, methodologies, tools, and P&Ps.
Training of business leaders on risk methodologies and provided training on how to foster a risk- conscious culture across multiple lines of business and a variety of audiences.
Risk management systems (RSA Archer) implementation, design, and development across multiple departmental user groups.
2015-2016
Manager Data Analytics • SIU/Program Integrity • AmeriHealth Caritas
Managed and recruited staff supporting all data analytical aspects of the end-to-end investigative process across a multi-organizational matrix within the managed care realm.
Oversaw contractual compliance and Fraud, Waste, and Abuse (FWA) activities across 8 state Medicaid contracts and served as a key contributor during CMS and DHS audits.
Led implementation activities for onboarding new state contracts, ensuring successful and timely implementation of FWA activities.
Coordinated preparation and delivery of all FWA reporting to internal departments, contracted lines of business as well as state and federal oversight agencies.
Built work schedules and staff assignments, taking workload, space, and equipment availability into consideration.
Planned and implemented programs for corporate and operational supporting personnel including administration and training.
Served as a subject matter expert in governmental programs.
2013-2015
Technical Team Lead • Program Integrity • AmeriHealth Caritas
Managed large scale projects across a complex organizational matrix including the integration of resources, outlining project requirements, introducing new concepts and processes, and driving completion of deliverables to ensure success.
Designed, implemented, and owned fraud prevention processes across an enterprise of companies both under ten months of leading beginning to operational (e.g., Prepayment Review, Sanction Provider and Member Service Verification processes)
Served as point of contact for contract negotiations of vendor services and project business owner with vendors.
Developed enhancements to the Program Integrity framework, policy creation, and system (FACETS) upgrades.
Established and implemented policies and procedures to support all state and federal contractual regulatory requirements, KPI metric reporting, and the design and implementations of the FWA software and case tracking tool STARS Solution Suite.
Systems
FACETS
MACESS
RSA Archer
STARS Solution Suite
Microsoft Office
IMAX
SQL Server
BI Solutions & Reporting
Zoom
Teams
SharePoint
Accomplishments
Exceptional reputation for delivering on objectives and outstanding performance in strategic and operational process planning and business process engineering.
Demonstrated success as an effective implementer with ability to create and communicate vision as well as re-engineered processes and programs to achieve efficiency and sustainability.
Created highly effective new programs that significantly impacted efficiency and improved operations.
Recognized in three different roles as an exceptional employee for outstanding performance and team contributions.
Routinely served as a concurrent business owner on multiple large-scale projects with the ability to ensure success and completion ahead of schedule.
Key Skills
Governmental Healthcare Systems: Regulatory Requirements, Risk and Compliance Management, Claims Payment, CMS/DHS Audits
Corporate Business Functions: Program Development, Project Management, New Business Implementation, Vendor Management, System Development/Implementation/Management
Leadership: Training and Development, Team Leadership, Behavior Modeling, Mentoring/Coaching
References
[Available upon request.]
Contact this candidate