I have been a part of nearly every workflow in the healthcare industry for over ten years. You can say that I truly know: "the life of a claim". I have first hand knowledge of how each role within a CDO is related to each other. I provide value based advocacy for process improvements in every role I am a part of. I pride myself on the financial contributions both in savings and in expertise. I independently seek problem solving solutions. I have vast knowledge on CMS claims processing guidelines and DMHC regulations. I am well versed with NCQA standards as well. I know my way around many industry information hubs and boards. My primary focus is on payor DOFRs with a specialty in dual and shared risk arrangements. I have extensive history reviewing claims appeals and grievances and payor cap deduction threats. I have a history in revenue and recovery for shared risk arrangements. Previously on the board of directors for a local non profit organization in my community. Our primary focus is endorsements and grassroot volunteering for community leadership. Since taking on a senior leadership position in the nonprofit sector, I have found myself to have gained lasting knowledge in an area few have the opportunity to acquire.I was an appointed delegate for SD 31 AD 58 2023 CADEM's Endorsing Convention. HIPAA + CMS + NCQA + DMHC + MAXIMUS + MEDICAID RECLAMATION + CLAIMS ADJUDICATION + MEDICARE + MEDICAID + ICD10 + CPT + HCPCS + + CMS1500 + UB-04 + MEDICARE LEARNING NETWORK + EAMS + EDEXIS + WORKERS COMPENSATION + TPL + SHARED RISK + GLOBAL RISK + DRG + APC + GAAP + SAVINGS REPORTING + MICROSOFT SUITE + DATA MINING + REVENUE SUMMARIES + PPLSOFT + DEPOSITS + AUDITING + PROVIDER CONTRACTS + PAYOR CONTRACTS + 501(C)(4) REPORTING + ICEFORHEALTH + APPEALS & GRIEVANCES + CAP THREATS + CAP DEDUCTIONS + SFTP DATA