● Tracked, identified, and reported trends for pend codes that affected claims auto adjudication process. Provided Ad-hoc reports to senior leadership. ● Analyzed contracts ensuring they met standards and were drafted within the company’s best interest while allowing fair and equitable payment to providers, serving both individual state health plans and national contracts.● Served as primary member of the training team. Travelled to several individual state health plans for in-depth training as well as conducted new-hire orientation/training for business analysts assigned to Marketplace. Provided 1-1 training for staff members/leadership as needed.● Researched escalated payment/provider issues to determine root cause. Once identified, ensured resolution was completed accurately and in a timely manner to avoid penalties, late fees or claims projects, and to prevent any future claim/provider issues.● Performed new implementation and/or integration of individual state health plans or national contracts. Created payment structures outlining detailed guidelines, rules, fee schedules, limitations, code sets, conversion factors, default rates, etc., as interpreted from provider contracts, CMS guidelines, state guidelines and specific health plan requirements.

● Increased Point of Service collections to over $300K for Patient Access, meeting and exceeding established collection goals. Increased accuracy rates to over 90%. Increased patient satisfaction scores to a 5-star rating.● Re-organized staffing to effectively run the department while maintaining man-hour statistics

● Increased Point of Service collections by 80%, establishing 2 records for highest collections of facility in over 3 years. Increased accuracy rates to over 90%. Increased and maintained patient satisfaction scores of 95%.● Selected as LEAN committee member, redesigned ER patient flow and processes to decrease left without being seen and door to doctor times. Served on several councils including Denial Management, Revenue Integrity, and Meditech Conversion/Installation.

● Increased Point of Service collections by 80%. Decreased bad debt/uncompensated care by 100K per month. Increased accuracy rates to 95%. Decreased staffing variances from 12 FTEs over to 1 FTE under budget without reducing staff.● Served on several councils including Service Excellence, Denial Management, Revenue Integrity, and Uncompensated Care