Angela McCave
Valley Grove
Summary
Detail-oriented healthcare operations professional with experience in risk adjustment, program coordination, and revenue cycle management. Proven ability to prioritize workloads, support leadership, and ensure member and business needs are met through accurate analysis, clear communication, and process improvement.
Overview
14
14
years of professional experience
Work History
LTSS Risk Adjustment Specialist
Centene Corporation
07.2024 - Current
- Review Pennsylvania InterRAI assessments for accuracy and compliance
- Provide feedback and guidance to Service Coordinators when discrepancies are identified
- Participate in business meetings with Service Coordinator agencies to review quarterly performance
- Collaborate with agency account managers to resolve issues and support training needs
- Develop job aids and process documentation to improve form completion accuracy
Program Coordinator
Centene Corporation
02.2023 - 06.2024
- Coordinated care activities and followed up on Health Assessment cases to ensure timely completion
- Managed assigned work queues and performed detailed case research
- Communicated with providers and Service Coordinators via phone, email, and virtual meetings
- Maintained accurate documentation, tracking, and data entry across systems
Account Manager
ECS
06.2016 - 02.2023
- Maintained daily, weekly, and monthly reports and spreadsheets to track performance and identify trends
- Audited billing processes and resolved accounts receivable and denials
- Researched claims and verified insurance eligibility
- Conducted monthly client calls to discuss performance metrics and address client issues
- Collaborated with multiple insurance plans, utilizing strong knowledge of payer policies to ensure compliance
Billing Specialist
Med3000
10.2011 - 10.2013
- Verified patient eligibility, resubmitted corrected claims to ensure accurate billing
- Researched unpaid and denied claims, submitted appeals to expedite resolution
- Trained new employees, supported physician office staff to enhance overall team efficiency
Education
High School Diploma -
Trinity High School
Washington, PA06-2000
Skills
- Risk adjustment and form review (InterRAI)
- Claims and denial resolution
- Data review and analysis
- Intermediate Excel skills
- Critical thinking and problem solving
- Professional communication and stakeholder collaboration
References
Available upon request.
Additional Qualifications
- Ability to work independently or collaboratively in team settings
- Adaptable to changing priorities and evolving processes
- Strong organizational and time-management skills
Leadership Experience
- Regularly presented cases to Medical Directors, leading discussions 1–2 times per week
- Independently facilitated meetings to address case barriers and operational challenges
Timeline
LTSS Risk Adjustment Specialist
Centene Corporation
07.2024 - Current
Program Coordinator
Centene Corporation
02.2023 - 06.2024
Account Manager
ECS
06.2016 - 02.2023
Billing Specialist
Med3000
10.2011 - 10.2013
High School Diploma -
Trinity High School