-Revenue Reconciliation -Audit & Risk-Claims Support / Reporting

Created revenue reconciliation monthly reports for 4 states. Tracked all professional capitation. Originated and streamlined shared risk process. Reported, analyzed, and audited revenue stream. Accurately reported revenue upwards of $1B. Transitioned with CareMore to Anthem in 2011.• Created and performed in-depth shared risk accrual calculation reviews and settlement preparations, generating quarterly and annual risk share reports.• Shared risk contract review and interpretation, tracking any contract changes affecting shared risk terms.• Produced AD-HOC report for accounting department, confirming payment data for thousands of members.• Provided lags and claims support, contributing to incurred-but-not-reported (IBNR) calculation by producing monthly summary.• Prepared monthly reports for accounting for claims, voids, manual disbursements, and capitation, reconciling general ledgers for month-end close.• Corrected over $2M in revenue payment of end-stage renal disease (ESRD) members by comparing revenue, authorizations, and claims.• Completed database integrity testing, ensuring accuracy of revenue information.• Effectively trained shared risk replacement in 1 month, eliminating need for additional educational resources.