27
years of professional experience
1
Certification
Over ten years of audit, paralegal, and research experience, computer operations, word processing, negotiation, and various office equipment. Areas of strength lie in training, excellent organizational, and customer service, communication skills, attention to detail, ability to meet deadlines and work under pressure.
Qualified healthcare professional experienced in treating patients' concerns with care, compassion and skill. Focused on helping patients improve physically and mentally for whole-body wellness. Works great with other disciplines to meet patients' unique needs.
Work History
Audit Provider Experience Manager
6 Years 7 Months- Assist with all audits assigned by state.
- Managed daily case load for assigned states to ensure timely audit preparation.
- Coordinated and supported audits for each designated state.
- Research all inventory through databases.
- Experience with Excel, SQL, Chart Point, Tracking System.
- Communicate with all auditors on a day to day basis to resolve and retrieve all record requests.
- Prioritize and Manage all day to day records.
- RCA tools used for assisting states assigned with CAP (Corrective Action Plan) for improving processing of records for audit review. Process used to improve inventory volume for facilities by IT technology data review.
- Followed up with hospitals via email, phone, mail, or fax to resolve claims inquiries.
- Ability to modify plans when needed to meet deadlines.
- Analytical ability to research and resolve audits with conflict information.
- Strong customer service and organizational skills to stay on top of changing workflow.
- Contributed to team objectives while managing tasks from a remote location.
- Managed invoice payments through Excel to ensure timely and accurate financial reporting.
- Research all data, trouble shoot all data issues
- Remote-March 2020-Present
Provider Experience Manager
6 Months- Assist with all audits assigned by state.
- Follow all rules and procedures
- Manage day to day case load for each state assigned.
- Schedule and assist all audits assigned to my states.
- Research all inventory through databases.
- Experience with Excel, SQL, Chart Point, Tracking System.
- Communicate with all auditors on a day to day basis to resolve and retrieve all record requests.
- Prioritize and Manage all day to day records.
- Use tools to stay current with all claims.
- Send spreadsheets to facilities to stay current with claims.
- Communicate with hospitals by email, phone, mail, or fax to follow up on all claims.
- Ability to modify plans when needed to meet deadlines.
- Analytical ability to research and resolve audits with conflict information.
- Strong customer service and organizational skills to stay on top of changing workflow.
- Remote work as needed
- Pay all invoices for state records
Audit/Billing Specialist/Operator
9 Years 9 Months- Review/investigate data to meet deadlines.
- Monitor audits to meet strict deadlines.
- Submit Physician Order Statement, Facility Proof of Delivery forms to verify documentation; contact facilities to obtain missing information.
- Verify compliance with HIPAA regulations prior to submitting audits.
- Prepare spreadsheets detailing data for CMS/ESRD audits.
- Research proof of delivery signature in firm's or company's database.
- RCA plan developed to save pharmacy a recoupment of funds over $300k per year. CAP plan created helped organize audit process with doctors/nursing on complying with all attestation/physician orders/proof of delivery requests.
- Obtain hard copy returned Kit Usage Forms from Kit Department on a daily basis.
- Scan forms into Document Imaging System.
- Submit claims for timely reimbursement.
- Complete data fields.
- Document account activity.
- Communicate with facilities to ensure billing requirements are met.
- Schedule and monitor weekly undocumented usage list.
- Maintain accurate and complete records concerning billing activity on kit usage.
- Maintain daily paper and electronic files of Kit Usage Forms.
- Other related duties and responsibilities that are necessary or appropriate to meet the needs of the organization.
- Follow applicable government regulations, including HIPAA.
- Fill electronic order refills through Omni DX database.
- Fill prescriptions/make compounds as requested by pharmacists.
- Billing Specialist
- Operator
- Assist with all order processing and inventory in day to day processing of patient orders. Trained and certified as an operator to perform all day to day activities. Ability to problem solve all faults as needed on a daily basis.
Litigation Coordinator
1 Month- Monitored and approved settlements and payment arrangements.
- Analyzed and resolved clerical issues on Massachusetts Judgments.
- Communicated legal support and relevant case law.
- Draft responses to Interrogatories, Discovery and Request for Admissions.
- Prepared files for trial; attended trial.
- Monitored post judgment collection efforts, including asset searching, locating defendants (skip tracing), writ of executions, bank and wage garnishments and property levies.
- (Time Payment)
Legal Records Clerk
- Filed legal documents into firm's management system and into database system.
- Prepared files for attorneys' cases, general administrative duties
Data Entry
- Entered data, researched, corrected and filed medical documents through PCPS system.
- Reviewed medical insurance documents to ensure accuracy; process data through system as new files opened reviewing contract provisions that physicians need in an agreement from the company.
Litigation Assistant
2 Months- Processed data entry legal documents to initiate litigation process.
Legal Assistant
1 Month- Prepared reinstatement/payoff letters and HUD/VA files for title insurance.
- Ordered VA/FHLMC BPOs and appraisals.
- Follow up on return of foreclosure documents.
- Prepared overnight packages.
- Completed assigned tasks in client websites.
Law Clerk
1 Year- Filed and scanned legal documents.
- Updated and reviewed information on financial statements.
- Researched prior cases and legal documents within Middlesex Probate Court.
- Assisted attorneys as needed in preparing for trial.
- Maintained and organized legal documents for office and litigators.
- Archived cases settled to offsite location.
Pharmacy Technician/Narcotics/Data Entry
6 Years 5 Months- Worked in Narcotic Room drug compounding and filling.
- Accurately filled prescription in a fast paced environment.
- Worked in teams with associates and pharmacists to process drug orders in a timely manner.
- Provided support to pharmacist, manager and supervisor in day to day activities.
Education
Masters - Communication & Organizational Management in Communication & Organizational Management
Masters - Negotiation & Leadership in Leadership
Bachelor of Science
Skills
Dictaphone
Excel
Microsoft Excel
Outlook
Power point
Billing
Scheduling
Microsoft Office
Microsoft Word
Management
MS Access
Legal Research
Westlaw
Filing
Word
Typing
Acrobat
Organizational Skills
Claims
Training
Medical Terminology
Data Entry
Collections
Accounts Receivable
Medical Billing
Epic
Accounts Payable
Receptionist
Internal Audit
Pharmacy Technician Experience
Legal Drafting
Word Processing
Analysis Skills
Transcription
Time management
Problem-solving
Teamwork and collaboration
Teamwork
Attention to detail
Problem-solving abilities
Multitasking
Multitasking Abilities
Reliability
Excellent communication
Critical thinking
Direct patient care
Organizational skills
Team collaboration
Active listening
Adaptability and flexibility
Decision-making
Electronic health records
Patient education
Physical examination
Team building
Pain management
Patient assessments
Medication administration
Self motivation
Task prioritization
Healthcare ethics
Health promotion
Preventive care
Coaching and mentoring
Technical troubleshooting
Analytical thinking
Interpersonal skills
Geriatric care
Care plan development
Professionalism
Interpersonal communication
Documentation and reporting
Crisis intervention
Patient advocacy
Time management abilities
Continuous improvement
Quality assurance
Critical care
Written communication
Treatment plan development
Adaptability
Risk management
Patient assessment
Staff development
Data analysis
Records management
Professional demeanor
Problem-solving aptitude
Care plan creation
Treatment Planning
Discharge planning
Electronic medical record software
Database management
Patient records analysis
Interdisciplinary collaboration
Contingency planning
Analytical skills
Medical coding
Accomplishments
- Optum RX
- First Level Emerging Leadership Program
- High Performing Teams Certification 2024, 2025, & 2026
- Omnicare Core Value’s
- April 2015
- Working with the audit team I showed through hard work, care, and commitment to my work. Since 2013 I have successfully assisted the audit team save over $20,000 or more on all desk audits received for our pharmacy hub location.
Certification
- RPHT license Mass Board of Pharmacy 2025
- 2026 100+ experience badges
Personal Information
- Title: Audits Provider Experience Manager
- Work Permit: Authorized to work in the US for any employer
Interests
High-Intensity Interval Training
Martial Arts
Playing Sports
Surfing
Wine Tasting
Team Sports
Gym Workouts
Swimming
Volunteer Travel
Additional Information
train all employees as requested by management on all billing duties as needed to assist with daily work.
2025 Marquis Whos who Award
2025 Honored Listee
Timeline
Audit Provider Experience Manager
OptumRx
04.2020 - CurrentRead More
Provider Experience Manager
EQUIAN LLC
10.2019 - 04.2020Read More
Audit/Billing Specialist/Operator
OMNICARE CVS HEALTH CO. OF NORTHERN MASSACHUSETTS
01.2010 - 10.2019Read More
Litigation Coordinator
MICROFINANCIAL
12.2008 - 01.2009Read More
Legal Records Clerk
ACCU FILE
09.2008 - 09.2008Read More
Data Entry
MULTI PLAN HEALTH CO
07.2008 - 07.2008Read More
Litigation Assistant
ZWICKER, P.C
01.2008 - 03.2008Read More
Legal Assistant
HARMON LAW OFFICES, P.C
03.2007 - 04.2007Read More
Law Clerk
ATWOOD & CHERNY, P.C
03.2006 - 03.2007Read More
Pharmacy Technician/Narcotics/Data Entry
NEIGHBOR CARE PHARMACY & LONG TERM CARE SERVICES
07.1999 - 12.2005Read More
Bay Path University
Masters from Negotiation & Leadership in Leadership
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Paralegal Studies Suffolk University
Bachelor of Science
Read More
Bay Path University
Masters from Communication & Organizational Management in Communication & Organizational Management
Read More