Managed Care Accounts Receivable
Resume:
Bringing over ** years of experience in managed care, a proven track
record of ensuring payment accuracy is in alignment with contracted rates. Skilled in reviewing and validating complex claim data, FWA compliance and identifying discrepancies/ fraud, and ensuring reimbursement compliance with payer agreements. Adept at supporting resolution processes and maintaining reimbursement integrity. Deep knowledge of managed care contracts, healthcare reimbursement policies, and industry standards, backed by two decades of hands-on expertise.
Employment history
Controller, Paradise Septic Aug 2021 - Dec 2023
Phoenix, AZ
Manager, Managed Care Contracting
Department, Albertsons Companies
Aug 2019 - Feb 2020
Boise
Finance Analyst, Albertsons
Companies
Nov 2017 - Nov 2019
Boise
Manage accounting functions, streamline operations, enhance reporting accuracy, reduce processing time.
Transitioned to cloud-based accounting, improved data accessibility, operational efficiency.
Developed inventory, cash flow strategies, improved accounts receivable collections. Collaborated with leadership for compliance, strategic insights, improved budget forecasting.
Mentored staff in accounting, fostered team cohesion, aligned financial goals with operations.
Analyzed financial trends to develop strategic budget forecasts, leading to improved resource allocation and operational planning.
Collaborated with executive leadership to resolve financial discrepancies, ensuring compliance and supporting strategic decision-making. Ensured contract compliance, optimizing terms for profitability and legal standards. Managed financial performance of 1,700+ pharmacies, ensuring accurate reporting and collections.
Negotiated complex contracts, identifying financial impacts to maximize profitability. Conducted claim analysis to ensure payments are in compliance with contracted rates. Reviewed claims to ensure FWA compliance.
Coordinated cross-functional teams to align on contract terms, fostering a culture of shared accountability and improved contract outcomes. Conducted financial analysis on claims, improving decision-making and aligning goals with company objectives.
Managed budgeting processes, enhancing accuracy and supporting strategic initiatives.
Created reports to track performance, identify trends, and uncover cost-saving opportunities.
Partnered with teams to develop models, ensuring cohesive project alignment and informed discussions.
Mentored junior analysts, boosting team capabilities and ensuring high-quality financial reporting.
Kimberly
Hudson
Investigator, SIU-(Remote)
5821 W Quintale Dr,
Meridian, United States,
83646
*************@*****.**
m
Skills
Contract Management
Financial Analysis
Project Management
Team Leadership
MS Office
Smartsheet
QuickBooks
Salesforce
MS Project
Process Improvement
Regulatory Compliance
Client Relations
Financial Reporting
Benefit Management
Operations
Management
Claims analysis
Employment history
Department Specialist III, Albertsons Companies Feb 2015 - Nov 2017 Boise
Manager, In-N-Out Burger Aug 2008 - Jun 2014
Menifee
Senior Implementation Account Manager, MedImpact
HealthCare Systems Inc.
Dec 1999 - Jan 2001
San Diego
Account Manager, MedImpact HealthCare Systems Inc. Jan 1996 - Dec 1999 San Diego
• Oversaw and facilitated strategic collaboration between clients and Pharmacy Benefit Managers (PBMs) to ensure seamless service delivery and adherence to contractual performance guarantees.
• Managed and nurtured ongoing client relationships, including conducting weekly briefings with senior management and coordinating client site visits as needed.
• Led the development and implementation of new products, ensuring alignment with market demands and client needs. Conducted claim analysis to ensure payments complied with contracted rates and FWA compliance. Supported financial management, ensuring consistency across departments, enhancing contract processes. Managed financial reporting, identified cost reduction and revenue opportunities, improved strategies. Analyzed contract terms, facilitated negotiations, reduced risks, Third Party Payer relationships. Completed all credentialing and attestations.
Developed centralized contract system, improved accessibility, efficiency, and reduced discrepancies. Fostered cross-departmental communication, aligned financial goals, improved organizational performance. Managed financials, reducing costs and boosting profits through strategic initiatives. Enhanced team productivity by mentoring, fostering growth, and maintaining accountability. Scheduled and coordinated tasks, promoting teamwork and meeting operational goals. Analyzed customer feedback to refine service offerings, leading to noticeable increases in customer satisfaction and repeat business.
Fostered a culture of teamwork by coordinating cross-functional training sessions, enhancing team cohesion and operational effectiveness.
Provided ongoing mentorship to team members, encouraging personal growth and leading to marked improvements in staff retention.
Led a team of 11, managing benefits for 19 million lives, enhancing service delivery. Conducted client visits, optimizing benefit structures and workflows for efficiency. Implemented new IT solutions, ensuring seamless integration and improved processing. Mentored Account Managers, fostering a culture of excellence in customer service. Developed SOPs and goals, aligning metrics with service agreements for success. Streamlined client onboarding processes, significantly reducing setup time and enhancing client satisfaction. Maintained comprehensive project documentation, ensuring compliance with industry standards and facilitating smooth audits.
Analyzed service delivery metrics, identifying areas for improvement that resulted in increased operational efficiency. Cultivated strong relationships with clients, enhancing trust and loyalty through proactive communication and support. Served as the primary point of contact for special requests and pricing negotiations, engaging cross-functionally with multiple departments to drive solutions.
Analyzed client feedback to enhance service offerings, resulting in improved satisfaction and retention rates across key accounts.
Coordinated cross-departmental teams to launch new products, aligning strategies with market trends and yielding notable market penetration.
Fostered lasting client relationships through regular updates and proactive issue resolution, enhancing trust and loyalty among stakeholders.
Courses
Pharmacy Technician Certification Jan 1990 - Jan 2001 California Pharmacy Technician License
Real Estate License Jan 2001 - Jan 2010
California Real Estate Commission
Contact this candidate