• Processed QC review for fee schedules built based on contract language, quarterly fee schedule updates & maintenance based on Medicare, and yearly full fee schedule updates based on Medicare’s first quarter update • Reviewed & Audited claims adjudication for compliance with contract rates & terms• Developed Single Network File Receipt & Validation Report Master Spreadsheets for tracking status of daily files sent & accepted at external processing company• Cleaned up unused and duplicate files in shared drive folder while reviewing fee schedules & combined fee maintenance file data into one QC Master Spreadsheets for quicker processing, review and tracking of files• Reviewed & processed fee configuration daily contract log spreadsheet corrections & fee schedule maintenance• Reviewed & processed older claims to catch up to state processing requirements• Created Fee Configuration User Guides, Work Instructions, and Reference Sheets• Reviewed & processed claim disputes for fee configuration

(Client - Centene WellCare)Short Term Project

(Client - AvMed)• Provided assistance with provider data entry & changes during client outsourcing and system transition to HealthRules Payor software• Built new participating physician & facility records in accordance with contractual or credential information provided• Resolved HealthRules Payor migration errors with Provider Data while processing claims to catch up & maintain State of Florida claims under 30 days processing requirements• Developed SOF Claims, SOF Claims 2Q and Encounters PDM Report Instructions• Developed PDM Reference Spreadsheet with Department claim processing notes• Processed older claims to catch up & maintain State of Florida claims under 30 days processing requirements

(Client - AvMed)• Provided assistance with provider data entry & changes during company outsourcing transition• Built and updated all provider records and demographical information for the provider network in all geographic regions• Loaded all non-participating providers and resolved provider set up issues that create pending claims• Ensured accuracy of data entry as provider record set up’s impact claims payment, directory publications, data interfaces with support system, and IRS reporting• Processed older claims to catch up & maintain State of Florida claims under30 days processing requirements

• Managed, administrated and supported users on Corporate Internal Sites, Navigation, Settings, Applications, Access & Permission Rights and Profiles• Provided guidance, support and training for site owners, teams and both internal & external company users on Architecture & Navigation, Managed Metadata, Settings and Collaboration Applications• Managed and administered site backups, restructuring & migration within SharePoint sites and reviewing of usage reports• Developed, configured, implemented, maintained & trained Staff on SharePoint Online O365 sites/ site collections for US Locations & Czech Republic division and SharePoint 2010 Intranet sites for all locations• Developed, configured and maintained department & project Document Libraries, Lists, Web Parts, Pages, Content Types, Managed Metadata, Calendars, Tasks, Out of the Box Workflows, Versioning, Templates, Taxonomy• Created SharePoint User Guides, Work Instructions, Standard Operating Procedures and Forms• Initiated, administered & supported new IT Help Desk SharePoint/Intranet category for better tracking and reference• Developed and implemented SharePoint procedures for internal and external users for company public viewed Government libraries on ADM Building project• Administered SharePoint communication, uploads and organization of construction data files with internal and external Construction Team users on ADM Building project• Validated SharePoint Server 2010 Operational and Production Qualification Protocol Text Scripts