Healthcare-State and County
Resume:
Gene D. Roney
Sacramento, Ca ***** PH: 916-***-****
**********@*****.***
EDUCATION:
****-**** ***** ******** *******
Masters Degree--Business Administration and Management
Rancho Cordova, Campus Ca.
EMPLOYMENT HISTORY:
10/9/2021--- Current
Contractor—RES Personal Business Company
Real Estate Professional
Investor based, Data Analysis of Inventory for purchase, Business Investment in
Sacramento County area.
1/97-5/01/2021 CCHP A/R Unit Director-Manager
Contra Costa County
1340 Arnold Dr. Suite 125
Martinez, CA 94523
Director/ Manager A/R Unit for CCHP
System setup and programming of Claims payment rules in Qiclink and Epic Tapestry System. Oversee Claims and Reporting for Hedis and DHCS reporting and Payments.
Setup and monitoring data code sets for system configuration. Auditing accuracy of setup.
Project Management and Coordinator as needed for Tapestry setup and maintenance.
System maintenance and input of provider data and Contract configuration. Ensure Provider payments and data is accurate. DHCS provider reports as required. Auditing of payment accuracy for provider contracts.
Oversee Authorization module for maintenance and changes. Manage Epic Referral Project into system.
Budget Planning for Department.
Budget Analysis for System Migration and Temporary help.
Management of, and Supervision of Check Cycle for review to Auditors office for claims payment to our providers. GL Project for Epic. Responsible for deposit and issuing of checks. Manage deposit and submission to Treasury 60 Million a month of funds received from State and 12-15 million dollars paid out monthly.
Input and extract of system data, monitor data for payment accuracy and system integrity, DHCS Audits.
Initiate and determine Forecasting for projects and system costs.
Ensure Hipaa Compliancy for member personal data CCHP.
Oversee and write report specifications for report writing unit within CCHP.
Review and Supervise the input of healthcare benefits into the Qiclink and Epic system. To accurately program the benefits within CCHP guidelines and rules. Verify Payment accuracy via fee schedules loaded into system. Medi-Cal and CMS schedules. RBRVS for non contracted.
Attend Local 21 Union meetings and work with Union stewards for positive outlook for Members and Staff for integration of Union policy.
Work with Union and Staff for complaints and new benefits as needed.
System troubleshooting when errors occur in the programming of Rims claims payment system. Epic and Qiclink system analysis and setup, Application coordinator on Epic Project Team.- Tapestry.
Review claims payment and pricing with system maintenance for accuracy of pricing for providers. Manage Provider Database for CCHP and Epic Project.
Setup of new Healthcare Plans for CCHP. Implementation of new plans into Rims. Monitor COB recovery, Payment accuracy via benefit payments by cpt code. Risk Adjustment-RAPS monitoring—CMS fee schedules. Hedis reporting setup review with Compliance and UM.
System maintenance of data codesets and conversion factors in Rims for accurate claims payment. CPT code Project for Epic System.
Management and overview of Student Services program with County HR. Ensure Student Services for County Student staff are maintained. Continue and support hiring process for CCHP on student workers. Management of Service and support of peer to student programs as needed.
Develop Policy and Procedures for workflows within the CCHP Departments and monitor staff to ensure all Directives are followed. Initiate new P&P as needed.
Management and Direction with CCRMC Hospital, FQHC Center—Teaching Hospital. Residency and Intern Students.
Acts as a intermediary with CCHP and Health Service I.T. support and programmers as well as I.T. Supervisors and Directors.
Manage and Oversee all I.T. projects for Health Plan, Medical grp setup and Hospital billing and reporting aspects.
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Epic Certified in Tapestry for 2019 Version, Tapestry Core, Benefits Engine,AP Claims-Benefits engine,Utilization Mgmt, Claims and Contracts..Can be recertified by testing the module needed.
References provided upon request
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