Managed Care Revenue Cycle

Cherry Saunders

**************@*****.*** 412-***-**** Pittsburgh, PA

SUMMARY Seasoned EPIC Tapestry Provider Auditor Analyst with 15 years experience in healthcare financial management and compliance. Expert in auditing, reconciling financial data, and developing pricing models; adept at managed care contract analysis. Seeking to leverage expertise as an EPIC Tapestry Analyst. WORK EXPERIENCE Texas Children’s Hospital’s Health Plan Remote Epic Tapestry Provider Auditor Analyst Apr 2022 - Sep 2024

• Audited provider contracts for Medicaid regulation compliance.

• Analyzed and implemented solutions within Epic Professional Billing to enhance revenue cycle processes.

• Provided application support and resolved issues for Epic Tapestry users.

• Collaborated with clinical and revenue cycle teams to refine system functionality.

• Conducted system testing and validation for upgrades and implementations.

• Documented system workflows, configurations, and customizations.

• Reconciled financial data to adhere to payor requirements.

• Configured and optimized Epic Tapestry for managed care and provider network operations.

• Generated data analytics reports to support managed care decision-making.

• Developed pricing models and aligned billing standards for financial accuracy and compliance.

Integrated Resources Remote

Utilization Management/Prior Authorization Lead Oct 2020 - Apr 2022

• Provided support for the Epic Tapestry module by troubleshooting and implementing fixes to ensure alignment with operational requirements.

• Configured and customized the Tapestry module to enhance managed care operations, provider networks, and care management workflows in compliance with organizational and regulatory standards.

• Generated reports and insights using data analytics tools to aid decision-making for managed care programs.

• Maintained seamless integration of the Epic Tapestry module with various Epic applications and third-party systems.

VACO Remote

Clinical Data Analyst II Jul 2020 - Oct 2020

• Analyzed clinical data to support financial reporting and billing accuracy.

• Provided daily support for system issues, implementing fixes to meet operational requirements.

• Configured and customized system modules to align with organizational goals and regulatory needs.

• Utilized data analytics tools to generate reports for managed care decision-making.

• Ensured integration of the system module with other applications and third-party systems.

• Developed and maintained pricing models for service bundles to support managed care.

• Performed financial reconciliations to align budget projections with actual expenditures.

• Coordinated system integration to enhance data processing efficiency.

• Contributed to Charge Master optimization for improved billing accuracy and compliance.

• Interpreted contract provisions to model financial impacts and monitored project alignment with goals.

Health Fidelity Clinical Services Remote

Medical Records Analyst May 2015 - Jul 2020

• Analyzed and reconciled financial data for bundled payment agreements, ensuring accuracy in pricing and reporting.

• Managed data within the EPIC system for record-keeping and analysis purposes.

• Collaborated on Charge Description Master data alignment, increasing consistency across multiple facilities.

• Contributed to billing practices through detailed analysis of Charge Master elements.

• Compiled monthly financial reports to monitor revenue trends and measure against performance targets.

• Interpreted managed care contracts and modeled their financial impacts for strategic executive planning.

• Delivered on project assignments, achieving results that aligned with or surpassed company objectives.

• Shared expertise within team-based initiatives, fostering improvement in collective outcomes.

• Ensured compliance with healthcare standards and company policies, upholding high-quality documentation.

• Pursued ongoing professional development to maintain knowledge of industry changes and best practices.

EDUCATION Master of Science in Health Administration Master of Science, Health Administration

2006

Bachelor of Science in Business Administration

Bachelor of Science, Business Administration

2004

SKILLS Epic Tapestry & EMR Systems Support • Data Analysis & Reporting • Claims Processing

& Coding • Policy Analysis & Compliance • Facets • QNXT • HealthRules • Project Management • CMS Audit Readiness • Provider Network Management • Strategic Planning • Problem Solving • Communication • Business Development • Data Analysis

• Epic Tapestry Certification • Healthcare Operations Knowledge • Problem-Solving • Report Writing • SQL Proficiency • Team Collaboration • Attention to Detail

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