Quality Assurance Revenue Cycle
Resume:
Janell Flores
Delran, NJ
************@*****.***
LinkedIn: Janell Flores
SUMMARY AND HIGHLIGHTS
Highly experienced and detail-oriented administrative professional with expertise in government, healthcare, and social services. Experienced in healthcare revenue cycle support, including claims submission, eligibility verification, denial prevention, and payer communications. Strong track record of cross-functional collaboration and process improvement in compliance-driven environments. Bilingual, with strong communication and analytical skills.
RELEVANT WORK EXPERIENCE
Internal Revenue Service, Philadelphia, PA 2024-2025
Examination Technician
●Reviewed and processed complex federal case files, ensuring documentation accuracy, legal compliance, and timely corrective actions—contributing to a streamlined appeals process.
●Audited Internal Revenue Agent time inputs across multiple campaigns, identifying and correcting discrepancies to maintain data integrity and compliance with federal standards.
●Conduct in-depth research and statistical analysis to support operational reporting, improve internal workflows, and provide actionable insights to leadership.
●Generated and maintained case inventory reports, enabling better scheduling, workload distribution, and cross-functional coordination among internal teams.
●Demonstrated exceptional attention to detail while independently managing repetitive documentation tasks in a high volume, fast-paced federal environment.
Internal Revenue Service; Philadelphia, PA, 2021-2024
Contact Service Representative
●Researched and analyzed taxpayer records to identify discrepancies, ensure compliance, and resolve balance due situations— supporting high standards of documentation accuracy and fraud detection.
●Utilized multiple IRS systems to securely access and evaluate sensitive data, ensuring accurate data entry and maintaining the integrity of confidential records
. ●Delivered clear, policy-based explanations to taxpayers through phone and written communication, consistently resolving complex inquiries with professionalism and empathy.
●Performed comprehensive account reviews to verify eligibility for credits and allowances, contributing to quality assurance and minimizing documentation errors.
●Managed high-volume administrative tasks independently, including data input and case documentation, while meeting deadlines in a fast-paced, detail-oriented environment.
Community Behavioral Health; Philadelphia, PA, 2020-2021
Member Services Representative
●Managed behavioral health documentation including grievances and census reports, ensuring accuracy, compliance, and timely submission—supporting ongoing quality assurance efforts.
●Coordinated inpatient and outpatient scheduling for members across various provider networks, demonstrating strong cross functional communication and operational support skills.
●Responded to high-volume member inquiries and crisis calls with professionalism and empathy, delivering clear information and helping direct care with strong verbal communication skills.
●Tracked provider availability and appointment logistics, contributing to streamlined scheduling processes and improved access to mental health and substance abuse services.
●Maintained detailed records and supported repetitive administrative workflows independently in a fast-paced, high-stakes environment requiring a high degree of focus and accuracy.
Caring Heart Home Care Services; Bristol, PA, 2017- 2020
Supports Coordinator
●Managed a caseload of 60+ participants, maintaining up-to-date documentation through HHA/eLTSS and MCO portals, ensuring accuracy and compliance with state and agency standards.
●Verified and updated participant care plans (InterRAI and Plan of Care) quarterly/annually, supporting quality assurance initiatives and contributing to efficient service delivery.
●Coordinated with multiple stakeholders including MCOs, Adult Protective Services, and community partners, demonstrating strong cross-functional communication and collaboration.
●Monitored service compliance by reporting suspected contract violations and abuse/neglect cases in accordance with OLTL policies—ensuring documentation integrity and participant safety.
●Tracked and communicated service changes to planning teams and providers, reinforcing attention to detail and the ability to manage repetitive administrative workflows independently.
365 Health Services; Philadelphia, PA 2012- 2019
Direct Care Worker
●Coordinated and monitored patient appointments, ensuring timely attendance and clear communication between clients, healthcare providers, and family members.
●Maintained accurate daily logs related to patient care activities, supporting documentation accuracy and contributing to quality assurance in a regulated care environment.
●Delivered consistent, routine-focused support to clients with a high level of attention to detail—demonstrating independence and strong time management in a fast-paced role.
●Provided essential non-medical support such as companionship and light housekeeping, fostering trust and effectively managing repetitive tasks with focus and care.
Human Resources / Administrative Assistant
●Maintained audit-ready personnel files and onboarding documentation, supporting compliance and ensuring document verification standards aligned with internal policies.
●Assisted with interview scheduling, background clearances, and reference checks, contributing to smooth operational support and efficient cross-functional coordination.
●Managed calendars, coordinated meetings, and processed office mail, demonstrating strong time management and attention to detail in a fast-paced administrative environment.
●Created and updated hard copy files and supported company audits, reinforcing documentation accuracy and quality assurance processes.
●Entered time and payroll data for new hires, ensuring accuracy and timely processing while adapting quickly to internal systems and tools.
Liberty Resources; Philadelphia, PA, 2006- 2010
Support Coordinator
●Conducted home care assessments and created individualized service plans, ensuring accuracy in documentation and compliance with care delivery standards.
●Maintained detailed progress notes and performed quarterly service reviews, supporting documentation verification and quality assurance efforts.
●Liaised with consumers and service providers to identify needs, resolve service gaps, and ensure accurate communication of support plans—demonstrating cross-functional coordination.
●Researched and submitted system corrections, contributing to continuous process improvement and accuracy in participant records.
●Provided administrative support, including filing, billing, and mail distribution, while independently managing repetitive tasks with precision and focus.
BHC Securities; Philadelphia, PA, 1998-2004
Stock Transfer Associate
●Maintained accurate shareholder registries and processed stock transfers and replacements, ensuring document integrity and compliance with regulatory standards.
●Verified and updated critical transaction records, supporting quality assurance and minimizing errors in high-volume financial documentation.
●Handled sensitive requests related to lost, stolen, or destroyed stock certificates, demonstrating exceptional attention to detail and commitment to accuracy.
●Issued and canceled physical stock certificates in coordination with internal operations and external stakeholders, showcasing cross-functional communication skills.
EDUCATION DIPLOMA, BUSINESS ADMINISTRATION
Mastbaum AVTS, Philadelphia,PA
LANGUAGES
Bilingual in Spanish; speaking and writing
VOLUNTEER EXPERIENCE
Dog Foster & Care Coordinator – J & CO Rescue August 2023 – Present
Contact this candidate