Experience

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  Western kentucky university

  Sept 1990 - Dec 1992

  Math lab tutor & dept secretary

  Student support staff in the Department of Mathematics under Dr. Robert Bueker. Worked in the Math Lab for Ms. Linda Pulsinelli and did independent tutoring part time.

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  Lamar advertising

  Jul 1993 - Oct 1993

  Receptionist

  Part-time receptionistLamar was known as "Universal Outdoor" at the time of employment

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  Anacomp

  Jan 1994 - Jul 1994

  Sales assistant
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  Sagamore health network

  Jul 1994 - Jul 1996

  Pho (managed care) supervisor

  Supervised Claims Processing, Monthly Capitation, Provider Inquiry and Enrollment functions for the St. Francis Health Network. Assisted in systems development of internally developed Access Database used for PHO claims processing and member enrollment data.Responsible for procedural documentation as well as examiner, enrollment and customer service representative training, auditing, attendance tracking, yearly reviews and disciplinary actions. Created departmental training schedules, auditing guidelines and attendance policies.Adjudicated claims for self-funded accounts according to PPO guidelines in RIMS claims processing system. Responsible for investigation and follow-up of pre-existing conditions and student enrollment status. Consistently scored highest in the department for claims accuracy and production. Completed HIAA Certification, Parts A & B. Show less

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  Women's health partnership

  Jul 1996 - Oct 1996

  Patient accounts coordinator

  Hired as the Physician Practice Manager to onboard new practices and synchronize learning and technology. Outstanding Accounts Receivable necessitated my intervention in first and third party collections. Left to return to the payer side of healthcare.

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  The healthcare group

  Oct 1996 - Jan 2005

  Claims manager

  Implemented outsourced functions and managed vendors for mailroom, data entry, claims processing and imaging services. Developed inventory reduction work plans, reporting criteria, various forms and workflows and over 100 formal policies for basic system navigation, responding to Customer Service inquiries, processing claims and managing pends and exceptions. Developed and maintained Access Database and auditing procedures for controlled production implementation of a claims processing system. Supported ongoing system development post-implementation. Identified, quantified and reported issues to the configuration team for resolution. Assisted Technical Services with the implementation of electronic claims receipt from various trading partners. Critical team member in increasing claims auto-adjudication from zero to 35 percent of electronically received claims. Tested, monitored and documented claims auto-adjudication rules. Show less

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  Pwc

  Jan 2005 - Jun 2018

  Manager, health industries

  Working with our commercial clients to assess healthcare information technology choices and provide due diligence for potential mergers. Bringing my healthcare payer and provider knowledge to inform our recommendations.Selected for two-year tour of duty with National Advisory Learning & Development. Lead faculty for Advisory Start Experienced, our onboarding program for experienced hires. Updated content and facilitator guides, assigned faculty presenters, trained client service coaches, and facilitated dozens of sessions sized from 30 to 200 learners. Created dozens of articles on Spark intranet site for new joiners, increasing subscriptions and tripling the number of views per day. Lead faculty for "Inspiring and Leading Teams" targeted to experienced managers and directors. Blended learning course lead, requiring WebEx presentations, intranet updates, and face-to-face delivery.Responsible for project management of provider revenue cycle initiatives including insurance identification and verification, claims coding and billing, and AR and denial management. Implemented HIPAA EDI transactions, software enhancements, and improved business processes. Oversight of multiple projects composed of up to 40 staff. Developed and delivered national training via Live Meetings, conference calls and face-to-face workshops. Managed relationships with external partners including the nation's largest electronic claims clearinghouse, contracted technology staff, the Centers for Medicare and Medicaid Services (CMS), a contracted Medicare Administrative Contractor and nearly every national third party payer and Blue Cross/Blue Shield plan. Cultivated relationships with regional business managers and local revenue coordinators as well as local points of contact for eBusiness initiatives. Show less

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  Western governors university

  Aug 2018 - Feb 2020

  Student

  Bachelors in Mathematics with Teacher Certification (Grades 5-12) *paused during full-time employment

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  The webb school

  Aug 2019 - Jul 2022

  Mathematics instructor

  Taught Geometry, Algebra 1, and AP Calculus AB at The Webb School, the oldest, continuously operating boarding school in the South. Educating for more than 150 years, our mission is "to turn out young people who are tireless workers, and who know how to work effectively; who are accurate scholars; who know the finer points of morals and practice them in their daily living; who are always courteous.”

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  Ensemble health partners

  Oct 2022 - now

  Revenue cycle specialist