HEALTH CARE LICENSE PROFESSIONAL MEMORANDUM:• Note to all potential Managed Care Organizations, Payers, Hospitals, Vendors, and Staffing Agency, or any Employers. The work experience below will only illustrate a snap shot of some of work and accomplishments completed based on the SOW obtained during my previous contract work as a Consultant. The Resume is not Black or White. This mean that, I am highly skilled and fully qualified to work for any Healthcare setting or Employers.• Overall Experience 10 years in the Healthcare Industry.• Experience working and building Health Plan LOB needs and supports using the SDLC Application Life Cycle (User Requirements, Systems Requirement, Analyst/Design, System Builds / Deploy, Implementation and Training)• Extensive knowledge of working with Medicare, Medicaid, Commercial, and Exchange LOB the full Life Cycle Support and Operations.• Working Knowledge with supporting medical billing and Medical Payments Based on contractual agreement for Physician and Hospitals Using QNXT Platform.• Experience working with Clinical Claims Comprehensive rules, current rules from commercial payer to CMS such as the following ( UB04/CMS Rules, HIPPA Rules, Payer Specific Rules, MAC Regional Rules, Medicare Coder Editor, Outpatient Coder Editor,Correct Coding Initiative, Local Coverage Determination, Medically Unlikely Edits, National Coverage Determination, HCPC/CPT/ICD, Outpatient Coder Editor and Providers Custom Rules.• Provider Relations Experience related small group and large practice operation for these Specialties: PCP, Specialist, Ancillary’s, Hospital’s, and DME• Managing Staffs and Training New hires were some of my additional duties as well as leading Major Projects which does not reflect below in details.• Familiar working SQL and Access Database for Data reporting.• Ability to adapt to a fast or slow paced environment.