Identify FWA opportunities for clients through data analysis and policy assessments. Work with clients and internal departments to assess current areas of opportunity for new product related to new trends in FWA, provider spend trends and current active capabilities within the active program integrity programs. • Actively collaborates with external and internal stakeholders to ensure that the analytical business needs are met in a compliant manner.• Leads Needs Assessment and creates a Requirements Documents• Driving excellent levels of service to the business, effective management & technology strategy development and ownership through defined process• Execute advisory management strategies including escalation management, streamlining delivery process, control of margins and operations• Identify areas of improvement to project management processes and implement changes as necessary;• Recommend the addition of new techniques to the Business Analytics portfolio based on strategic goals of the organization and gaps in current capabilities

Senior healthcare economic consultant . Certified coder, certified medical professional auditor, RN. Expertise as a reimbursement specialist for professional, Outpatient and inpatient claims, data/ policy gap analyses, including clinical auditing skills, creation of business requirement documents, data quality analysis, UAT requirement creation and SQL. Experience with adjudication of all claim types including working knowledge of multiple DRG payment methodologies. Experience with multiple lines of business within Commercial plans, Medicaid and Medicare plans for cost saving measures and proper adjudication of claims. Conference presentations for cost savings and gap analysis. Able to provide expert witness testimony during hearings in the appeal process. My work also involves consulting and quality assurance reviews for algorithms/ data already developed.

I was a reviewer of records and investigated issues that lead to the incorrect reimbursement of claims through improper billling or policy/regulatory issues.

I was a work comp claims examiner that reviewed cases for determinations of benefits and worked with the injured workers and providers to enable the workers to return to work as soon as possible with the highest level of function. I also worked with the legal department when return to work was not feasible for settlement purposes.