Summary A seasoned professional with years (since 1994) experience in the management and administration of day-to-day operation for the insurance industry and a local non-profit organization. Significant experience in Medicare Part A and B Claims analysis, Recovery Audit Contractor Data Warehouse (RACDW), HIPAA assessments and implementations including impact assessments, gap analysis, requirements documentation, transaction mapping, and code set crosswalks and creation of ANSI data files for 837, 834 & 820 HIPAA Transaction Sets. Major strengths in project management, business development, workflow production, research and analysis, problem solving, heavy customer service inter-action, help desk support, staffing and personnel administration and general ledger accounting. Proven internal leader in implementing policies, procedures, and strategy initiatives. A dependable, thorough and well organized planner with a successful track record in loss prevention, increasing personnel morale and productivity, and technical expertise in audit and compliance regulations including HIPAA. Clients include CMS, major healthcare payers, state Medicaid agencies, state and county health care agencies, hospitals, managed care companies, health information networks, vendors and industry groups. SME in the area of Medicare Part A and B, HIPAA Administrative Simplification legislation and its impact on electronic commerce in healthcare including ASC X 12 Transactions (834, 837, 835, 820, 997, 999, etc.), standardized codes and privacy. Participant in WEDI-SNIP workgroup.

Highlights:

• Health Insurance Portability And Accountability Act
• Management
• Project Management
• Medicare
• SDLC
• Project Manager
• Sybase
• ANSI
• Ansi (Am Natl Stds Inst)
• Collection