Manage Pricing Transparency projects to ensure hospital compliance per Center of Medicaid Services (CMS) guidelines. Coordinate 835 and 837 data from the client with our data team to ensure accuracy and compatibility. Model payer contracts in Manage Care Rules Engine (MCRE) and coordinate with data team to ensure payor plan listing are mapped correctly. Develop and review Machine Readable Files (MRF) for Pricing Transparency clients. Coordinate the CMS shoppable services with clients and Revenue Integrity team to ensure CMS requirements are being met Coordinate with the IT Development team to Ensure Consumer Display (CD) has met the MRF, Shoppable services and all pectinate CMS requirements. Coordinate enhancements with the development team to ensure MCRE is current with all CMS updates and payor contract requirements.

Fifteen years of specific experience in the health care industry where the main focus is on assisting provider, payor, and employer group clients. Specializing in DSH (Disproportionate Share Valuation), National Hospital Benchmarking, and TPA (Third Party Administration) claim audit reviews.

Responsible for short and long-range planning, programming, execution and evaluation of Children & Youth Services (C&YS) programs. Analyzed and planned for resources such as funds, manpower, equipment, and supplies to ensure current and future C&YS program effectiveness.