• Proactively implement process improvements to meet/exceed specific client goals.• Develop and implement new Coordination of Benefits audit opportunities.• Focus on overall productivity through advanced algorithm outputs to drive revenue.• Leader for segment teams and special projects.• Conduct production analyst team audits and recommend improvements.• Forecast and plan for resource requirements.• Ensure business objectives and goals are met through innovative solutions.

• Responsible for performing comprehensive research and identifying billing abnormalities, problematic billing practices and irregularities.• Examined, researched, and analyzed claims data, applying client medical policy knowledge to determine details of fraudulent or abusive billing activity.• Performed audits of provider records, clinical records, and itemized bills to ensure proper billing practices and application of client policies. • Identified and documented fraudulent or erroneous activity during audits; determining indisputable overpayments.• Developed, collected and analyzed metrics and data to formulate fact based decisions while proactively implementing process improvements for individual clients.• Created, owned and updated Policy and Procedure (P&P) trend manuals. • Forecasted and maintained distinct client cases, as well as analyze monthly Target vs. Actual variances.• Directed/coordinated newly created case/trend kick-off calls with Operations to ensure correct process execution. • Generated, tracked and managed all trends, case revisions, test files from inception to conclusion via SharePoint.

• Diagnosed and validated provider raw data file sets, mapping provider files for development transition into databases, created custom logic and implemented standard account rules.• Directly responsible for the continued maintenance of all Business Intelligence projects through query derived resolution, quarterly functionality reports and monthly meetings with on-site provider staff and users.• Independently created insurance bucket balance recovery resolution custom logic yielding increased potential refund opportunity.• Developed, utilized and applied analytical techniques to expedite the resolution of problem patient accounts for clients generating additional efficiencies.• Collaborated in BI discovery brainstorming sessions to explore innovative concepts, apply new processes and set standard operating procedures. • Trained internal and external ExpressClaim users on how to utilize and maximize results through the web based application.• Extensively experienced with PHI file formatting, encryption, decryption, transfer protocol and translation of transaction based data for the purposes of deriving Business Intelligence.

• Resolved provider credit balance and overpayment variance accounts across middle Tennessee territory through examination of hospital contract information with financial transaction data to determine the root cause of billing errors.• Relationship development from Provider Director level, including Business Office Management and Contract Modeling Management, to Refund Clerks and Recovery Analysts.• Recoveries > 98% accuracy: met and exceeded all quarterly goals pertaining to volume of reviewed accounts, recovered dollars, project creation/development and identifying potential new lines of business with existing healthcare providers. • Assisted corporate Accounts Receivable and Client Service departments with claim/refund adjudication and recoveries.• Utilized McKesson, STAR, IDX and HCA provider accounting systems in revenue recovery and credit balance resolution projects.• Experienced with direct client contract analysis utilizing Revenue codes, CPT codes, DRGs, Medicare COB, Per Diem rates, and ICD-9 codes to determine the proper method of payment while identifying reoccurring trends in client billing data. • Successfully collaborated with provider Business Office Manager at Wayne Medical Center through relationship building to penetrate parent hospital Maury Regional in order to carry out our credit balance services onsite.

• Managed Mid-Atlantic territory claims analysis and processes, which included over 100 Regional Account Managers.• Directed monthly territory Accounts Receivable conference calls among Assistant Vice President, National Director, Regional Directors, and Assistant Regional Directors.• Tracked top percentage Providers regarding projections vs. paid.• Corresponded daily with Providers regarding settlement of outstanding claims.

• Opened new product accounts for businesses and regular customers. • Settled all cash drawers, and balance of entire Westside Branch.• Responsible for cash drawer with no dollar limits.

• Managed entire operations for the South Church Street branch. • Experienced in all departments – Head Teller, Operations and Loan departments.• Tennessee Bankers Association.