• Oversaw vendor contracts and managed claims payments. Managed revenue cycles and member benefits to optimize operations.• Researched and analyzed current and past financial trends and performance. Provided insights to improve business results.• Supervised cash reconciliations, payment date accounting, monthly reporting, and report production. Handled daily modeling, analysis, and reporting of financial data.• Prepared financial reports, charts, tables, and other exhibits for clients. Utilized financial analysis techniques, tools, and concepts to provide practical counsel to business partners, SMEs, and client managers.• Provided advanced analytical support for business operations in areas such as claims, provider data, member data, clinical data, pharmacy, and external reporting. Extracted, loaded, modeled, and reconciled large amounts of data across multiple system platforms and sources.• Reviewed data to determine operational impacts and necessary actions. Escalated issues, trends, and areas for improvement to upper management, including the CFO.• Developed reports and deliverables. Made recommendations to client management and leadership.• Modeled data using MS Excel, Access, SQL, and other analytical tools. Ensured compliance with federal and state deliverable reporting requirements by performing data quality audits and analysis.• Met with clients to discuss Quarterly Business Reviews (QBRs). Presented effective solutions with the mission and vision of scaling their business operations in an ever-changing and challenging market.Skills: Vendor Contracts and Revenue Cycle Management, Financial Trend Analysis, Cash Reconciliations and Reporting, Advanced Analytical Support, Operational Impact Analysis, Data Modeling and Analysis, Client Meetings and QBR Leadership

• Managed claims audit and payment operations, provider enrollment, and payments data. Generated dashboards, daily, weekly, and monthly reports.• Monitored productivity and ensured monthly quality control and compliance with all client security and privacy requirements, including Blue Cross Blue Shield of New Jersey.• Worked with clients to negotiate claim case-loads within the scope of OON Mandate, state and federal regulations, and self-funded (ASO) contracts.• Led negotiations to achieve savings for the company and clients, focusing on reducing costs for health plans and providers with average savings of $1.5 million per month.• Coached teams on best practices within state and federal mandates, saving substantial costs for members, government and private self-funded plans, healthcare providers, and clients.• Handled healthcare provider and client-related escalations timely and effectively under the supervision of the General Counsel’s Office.• Monitored medical claims adjudication and payment processes within revenue cycle management to ensure payment integrity for all parties involved.• Developed and enhanced strategic business partnerships by fully engaging and building trust with healthcare providers and their stakeholders.• Collaborated with senior leadership to ensure client satisfaction, top-quality client care, and maximum results for providers, plans, and members.Skills: Claims Audit and Payment Operations, Revenue Cycle Management, Productivity and Compliance Monitoring, Negotiation and Case Load Management, Cost Savings Negotiation, Best Practices Coaching, Escalation Management, Claims Adjudication and Payment Monitoring, and Strategic Business Partnerships

• Oversaw the billing process for medical claims, ensuring accuracy, timeliness, and compliance with industry standards and regulations.• Analyzed billing data to identify trends, discrepancies, and areas for cost savings, providing actionable insights to clients.• Collaborated with clients to optimize the revenue cycle, including billing, collections, and payment processing, to improve cash flow and reduce claim denials.• Ensured compliance with financial regulations and standards, such as GAAP and insurance industry guidelines, to avoid penalties and legal issues.• Supported internal and external audits by providing necessary financial documentation and analysis related to billing processes and claims.• Leveraged billing software and analytical tools to streamline the billing process, enhance data accuracy, and improve reporting efficiency.• Provided training and support to clients' billing staff on best practices, software use, and regulatory compliance.• Monitored and controlled costs associated with the billing process, identifying opportunities for cost reduction and efficiency improvements.• Developed and tracked key performance indicators (KPIs) to measure the efficiency and effectiveness of billing operations.• Acted as a liaison between clients, healthcare providers, and insurance companies to resolve billing issues and ensure smooth operations.• Assisted clients in developing and implementing billing policies and procedures to ensure consistency and compliance.Skills: Claims Billing Management, Financial Analysis, Revenue Cycle Optimization, Regulatory Compliance, Policy Development, Audit Support, Cost Management, Performance Metrics, Technology Utilization, Staff Training and Development

• Oversaw the agency’s medical claims payments, collections, and audit department, ensuring timely and accurate financial transactions within an annual budget of $11 billion.• Led investigative fiscal and accounting audits for the State Accounting Office and the Centers for Medicare & Medicaid Services. Enforced state and federal fiscal policy guidelines, ensuring compliance with the agency’s fiduciary responsibilities.• Hired, coached, trained, and promoted subject matter expert (SME) employees in data analytics, finance, accounting, financial reconciliations, research, and analysis. Fostered a team-oriented environment to improve departmental performance and employee development.• Utilized systems and tools to perform data analytics, identifying service trends to support established metrics and measurement goals on small to medium scope projects.• Documented business processes and identified opportunities for process redesign to enhance operational efficiency.• Proactively recommended operational efficiency and performance enhancements based on data analysis.• Created analytics reports and provided recommendations to drive business improvements on medium to large scope projects.• Streamlined workflows, improved delivery, and aided in long-term strategic planning to enhance overall organizational performance with average annual cost savings of $18 million.Skills: Management of Claims Payments and Collections, Fiscal and Accounting Audits, Data Analytics and Trend Identification, Business Process Documentation and Redesign, Operational Efficiency Recommendations, Analytics Reporting and Business Improvements, Workflow Streamlining and Strategic Planning, and Staff Management and Development

• Analyzed financial data related to medical claims to identify trends, discrepancies, and areas for cost savings.• Assisted in the development of budgets and financial forecasts based on historical claims data and projected healthcare costs.• Monitored and controlled costs associated with medical claims, ensuring efficient use of resources and identifying opportunities for cost reduction.• Prepared detailed financial reports and presentations for management, highlighting key findings and recommendations.• Interpreted complex financial data and translating it into actionable insights for department’s director and agency’s Chief Financial Officer.• Evaluated the financial risks associated with claims, including the potential impact of large claims and/or changes in healthcare policies.• Ensured compliance with financial regulations and standards, such as GAAP (Generally Accepted Accounting Principles) and insurance industry guidelines.• Analyzed and set reserves for outstanding claims to ensure that the organization had adequate funds to cover future claims liabilities, State and Federal funds.• Collaborated with other departments to optimize the revenue cycle, including billing, collections, and payment processing.• Supported internal and external audits by providing necessary financial documentation and analysis related to claims.• Developed and tracked key performance indicators (KPIs) to measure the efficiency and effectiveness of claims processing and financial management.• Leveraged financial software and analytical tools to streamline data analysis and reporting processes.• Worked closely with actuaries, underwriters, claims adjusters, and other stakeholders to ensure accurate financial assessment and reporting of claims data.• Assisted in the development and implementation of financial policies and procedures related to claims processing and financial management.

• Provided operational direction and leadership for areas of professional billing, charge capture, follow-up, insurance cash application (including credits, refunds, and cash posting).• Coached and trained staff in maintaining and enforcing adherence to revenue cycle policies and procedures, along with internal controls.• Managed case workloads of claim inventories against adjudication denials and rejected appeals through strict compliance policies, increasing revenues for primary care providers and surgeons. • Worked closely with business analysts to implement improved billing systems, identify opportunities for system and process improvements, and drive change through targeted initiatives.• Collaborated with senior leadership to achieve key metrics and reach business strategic objectives.• Directed business and financial analysis units, helping providers save costs and recover payments by an average of $3 million annually.• Led public instruction and seminars for provider communities and medical associations to ensure compliance with policy reimbursement and recovery guidelines.• Trained billers to submit claims via paper, web, and EDI software applications, effectively managing revenues from the point of patient encounter to collection of payments and cash posting.• Traveled and met with business partners to effectively manage revenue cycles.Skills: Operational Direction and Leadership, Claims Management, Revenue Cycle Management, System and Process Improvements, Strategic Objectives, Financial Analysis and Cost Savings, Public Instruction and Compliance, and Claims Submission Training.