Project Manager Quality Assurance
Resume:
Kevin R. Hanington
Union, KY 41091
513-***-**** **********@*****.***
OBJECTIVE
To obtain a Management Position with an organization that will allow me to fully utilize my skills and experience while offering a challenging work experience.
BUSINESS EXPERIENCE
Wellpoint/Anthem BC/BS
Manager, Medicare Operations (6/05-3/09)
Responsible for Quality Assurance and Medical Review of approximately 54 million Medicare B and DMERC claims annually. Managed a Quad-state Medicare B and DMERC Claims Operations with a team of 34 exempt and non-exempt associates while at the same time ensuring timely and accurate claim adjudication. Dedicated to the J13 Part A and B MAC contract to ensure highly visible inquiries received the utmost attention and timely response. Coordinate the resolution of Inquires from CMS, Attorney General Offices, Congressional Offices, Provider Associations and individual Provider from a claims processing perspective.
Program Manager, Part A (8/04-6/05)
Program Manager for the Contractor Operations Workgroup (COW). Responsibilities included the development and implementation of consistent processing of files, operational processes and procedures within the East and Mid West regions. Assisted the Part B Claims unit with the Multiple Carrier System (MCS) transition and reducing the claims inventory.
Director, FI Operations (5/03-8/04)
Managed a quad-state Medicare Part A Business Systems Operations (BSO) department and a Call Center that was responsible for answering 430,000 phone calls annually from quad-state Medicare Providers and Beneficiaries. Ensured timely and accurate responses to 26,000 pieces of correspondence received from quad-state Medicare Providers and Beneficiaries yearly. Led a team of 70 to 75 exempt and non-exempt staff; that would investigate, develop, and implement methods/procedures to support continuous improvement in efficiencies of staff, operations, and systems. Developed and monitored the budget for multiple cost centers, prepared written responses and participated in fact finding sessions for multiple internal and external audits such as SAS70, CFO, System Security, and CMS on site reviews. Prepared and analyzed monthly production reports; ensured proper procedures and controls were in place to track and evaluate compliance with federal and state regulations, CMS contract mandates, and the measurement of quality production. Presented monthly compliance training to staff. Served as project manager on an as needed basis to coordinate activities of multiple sites to meet project deliverables.
Senior Manager, FI Operations (1/02-5/03)
Managed a quad-state Medicare Part A Business Systems Operations (BSO) department responsible for maintaining the Fiscal Intermediary Shared System (FISS) processing system which processed approximately 20 million claims annually. Ensured timely and accurate file updates to core system which impacted the adjudication of Medicare Part A claims and adjustments. Managed a team of 10 exempt and non-exempt associates. Investigated, developed, and implemented methods/procedures to support continuous improvement in efficiencies of staff, operations, and systems. Developed and monitored the budget for multiple cost centers. Prepared written responses and participated in fact finding sessions for multiple internal and external audits such as SAS70, CFO, System Security, and CMS on site reviews of release testing. Prepared and analyzed monthly production reports along with ensuring proper procedures and controls were in place to track and evaluate compliance with federal and state regulations, CMS contract mandates, and the measurement of quality production. Presented monthly compliance training to staff; while serving as project manager on an as needed basis to coordinate activities of multiple sites to meet project deliverables.
Manager, Medicare Claims Processing (3/94 – 1/02)
Managed a statewide Medicare Claims department that was responsible for processing approximately 6 million claims annually. Ensured timely and accurate adjudication of Medicare Part A claims and adjustments with a team of 8 to 33 exempt and non-exempt associates. Investigated, developed, and implemented all methods/procedures to support continuous improvement in efficiencies of staff, operations, and systems.
Supervisor, Medical Review (8/93 to 3/94)
Supervised clinical staff responsible for the medical review of suspended claims requiring additional development.. Maintained workflow and met production and timeliness requirements. Developed staff to validate and ensure correct coverage for Medicare beneficiaries; monitored quality assurance (QA) activity and reviews conducted by Senior Analysts.
Supervisor, Medicare Claims Processing (8/88 to 8/93)
Supervised staff responsible for the day-to-day claims processing activities for Medicare Part
A claims. Established and implemented processes for performing random audits of claims to ensure compliance with Medicare law and the Health Care Financing Administration (HCFA) regulations. Developed and implemented processing policies/procedures as mandated by HCFA or corporate directives. One major accomplishment during this time was developing performance plans for staff that incorporated cross-training and ongoing education of Medicare regulations and developing a program for measuring quality assurance and identifying training needs.
Supervisor, Mailroom (8/85 to 8/88)
Supervised staff responsible for processing and distribution of all incoming and outgoing mail. Monitored 1.2 million-dollar operation budget and prepared monthly variance reports for department manager. Ensured timely mailing of Medicare reports to 800 providers; directed the filing/retrieving process for Medicare claims/ correspondence for a beneficiary base of 440,000. Monitored the use and maintenance of postage/inserting equipment and delivery vehicles.
SKILLS Microsoft Word, Outlook, Excel and Power Point
EDUCATION University of Kentucky, 1981 Bachelor of Science – Accounting
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