Revenue Cycle Analyst /Coverage analyst

SHEILA McCRAY

Tampa, FL Remote Available Nationwide

HFMA-CRCR · HFMA-CSPR · CITI CTBC · CPC Candidate (AAPC)

PROFESSIONAL SUMMARY

Clinical Trial Systems and Compliance Specialist with hands-on OnCore CTMS administration experience at Moffitt Cancer Center, an NCI-designated comprehensive cancer center. Expertise spans system configuration, end-user training, billing calendar builds, and CTMS-to-billing workflow integration — supported by deep command of NCD 310.1 coverage analysis, Medicare/Medicaid research billing, and CMS regulatory compliance. Holds HFMA-CRCR and HFMA-CSPR certifications. Known for translating complex protocol requirements into compliant, operationally sound billing and systems workflows across multidisciplinary research environments.

PROFESSIONAL EXPERIENCE

Sr. Hospital Billing Specialist / Revenue Cycle SME Feb 2019 – Apr 2025

Moffitt Cancer Center · Tampa, FL

•Administered OnCore CTMS at an NCI-designated comprehensive cancer center — managing study builds, billing calendar configuration, user access provisioning, and data integrity audits across active oncology clinical trials.

•Conducted end-user training and developed instructional materials for cross-functional staff on OnCore workflows, CMS charge routing, and clinical trial billing compliance procedures.

•Performed systematic quality audits across OnCore and Cerner, identifying and resolving billing grid discrepancies, protocol order mismatches, and eligibility gaps before claims submission — protecting institutional compliance standing.

•Executed NCD 310.1 coverage analysis for complex oncology trials, accurately segregating standard-of-care from research charges and ensuring correct routing within integrated CTMS and billing systems.

•Managed data interfaces between OnCore, Cerner, and billing platforms — maintaining workflow integrity across clinical research and revenue cycle operations.

•Translated CMS final rules, transmittals, and Medicare manuals into operational billing requirements, serving as the institutional SME for evolving regulatory requirements affecting research billing.

•Partnered with IT and revenue cycle leadership on root cause analysis of denial patterns and system-level process improvements — reducing claim error rates and accelerating resolution cycles.

Sr. Medicare Reimbursement Specialist Jun 2016 – Feb 2019

Chapters Health Systems – Lifepath Hospice · Temple Terrace, FL

•Managed Medicare Part A and Part B billing operations for hospice services, maintaining high claim accuracy and full CMS compliance across daily submission volumes.

•Conducted systematic claim edit audits that consistently reduced denial rates and identified automation opportunities improving operational throughput.

•Handled ADR responses and first- and second-level appeals, resolving complex coverage disputes and protecting revenue integrity through compliant documentation.

•Performed Medicare and Medicaid eligibility verification across multiple systems, escalating and resolving discrepancies before they impacted reimbursement.

Sr. Billing Specialist – Hospital & Physician Services Dec 2013 – Jun 2016

Moffitt Cancer Center · Tampa, FL

•Managed high-volume Medicare and Medicaid claims processing for oncology billing operations with emphasis on reimbursement optimization and denial resolution.

•Conducted detailed charge audits against medical records including specialized audits for Interventional Radiology, directly protecting charge capture integrity.

•Identified denial root causes and payment variances, developing preventive solutions and partnering with IT and revenue cycle leadership on system-level enhancements.

Sr. Claims Reimbursement Specialist Oct 2009 – Dec 2013

USF Physicians Group · Tampa, FL

•Managed AR and third-party payer denials across Medicare, Medicaid, and commercial payers for high-complexity NICU and labor & delivery claims.

•Resolved payment variances through systematic appeals and proactive payer outreach, consistently meeting CMS accuracy standards.

Sr. Claims Specialist / Medical Review Claims Coordinator 1996 – Oct 2009

Gentiva Health Services · Tampa, FL

•Oversaw Medicare and Medicaid home health billing across portfolios valued at $1M–$2M, sustaining high collection rates through ADR management and multi-level appeals.

•Developed and delivered Medicare billing training for newly acquired agencies, ensuring rapid staff compliance across all levels.

•Maintained productive relationships with Medicare Administrative Contractors (MACs) to resolve complex claim disputes and support audit readiness.

CERTIFICATIONS & PROFESSIONAL DEVELOPMENT

HFMA-CRCR — Certified Revenue Cycle Representative — Healthcare Financial Management Association

HFMA-CSPR — Certified Specialist, Payment & Reimbursement — Healthcare Financial Management Association

CTBC — Clinical Trials Billing & Contracting — CITI Program

CPC — Certified Professional Coder (Candidate, In Progress) — AAPC · CPT, ICD-10-CM, HCPCS, medical necessity & payer compliance

TECHNICAL PROFICIENCIES

Systems & Platforms: OnCore CTMS · Cerner · Availity · Waystar · EHR/DRG Platforms · Florence eBinders · Revenue Cycle Management Systems

Core Competencies: CTMS Administration · Study Build & Calendar Configuration · User Access Provisioning · End-User Training · Workflow Documentation · System Validation · NCD 310.1 Coverage Analysis

Productivity: Microsoft Office Suite (Excel, Word, Outlook) · Data Reconciliation & Reporting · Spreadsheet-Based Claims Analysis

Coding (In Progress): CPC Candidate (AAPC) · CPT, ICD-10-CM, HCPCS Level II

References available upon request

Contact this candidate