Summary
Overview
Work History
Education
Skills
Timeline
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CHARLOTTE HALLEY

CHARLOTTE HALLEY

Parkville,MD

Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Highly-trained individual and skilled communicator effectively interacts with patients, staff and other healthcare professionals. Strong knowledge of medical terminology and HIPAA regulations. Demonstrative Claims Auditor with background reviewing payment processes to deliver services, correct pricing and timely payments. Highly collaborative individual with over 8 years providing exceptional service to various individuals and organizations. Offering experience in different software applications and accounting procedures.

Overview

29
29
years of professional experience

Work History

Quality Assurance/Quality Compliance Manager

MV Transportation
06.2022 - Current
  • Deliver subject matter expertise for internal and external (Maryland Transit Administration) customers on compliance best practices and quality control by managing decreasing liquidated damages by 20% over two years.
  • Consult with clients MTA on best practices and serve as project manager for all process improvements and regulatory initiatives. Collaborate with cross-functional teams such as Safety, Operations, and Training for continuous improvement initiatives, resulting in increased KPI performance.
  • Wrote and implemented new rework procedures to standardize processes and streamline workflow.
  • Evaluated quality problems and performed assessments to identify and resolve issues.
  • Increase customer satisfaction as Customer Service Manager through adherence to quality standards and customer requirements.
  • Conducted comprehensive audits to identify gaps in compliance, leading to improved regulatory adherence

Senior Quality Claims Auditor

Cigna
01.2014 - 02.2022
  • Prioritized daily tasks to satisfy workload demands and department's turnaround goals.
  • Initiated cost containment by conducting thorough audits and data mining.
  • Researched issues related to claims processing to identify origins and implement corrective solutions.
  • Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues.
  • Used QNXT systems to review and release medical claims for payment.
  • Assisted with development of Policy & Procedures guideline for auditing department.
  • Completed 40 - 50 audits daily consisting of high dollar claims, facility, physician, Medicaid Texas, and home health claims.
  • Mitigated potential risks associated with high-dollar claims by carefully analyzing relevant data points before arriving at final determination

Collections Manager

Sentient Medical
01.2013 - 01.2014
  • Verified claim data correctness in preparation for processing.
  • Reviewed history records to determine benefit eligibility for services.
  • Researched medical claims for validity to resolve discrepancies.
  • Complied with confidentiality regulations in handling customer information.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Collaborated with fellow team members to manage large volume of claims.
  • Examined claims, records and procedures to grant approval of coverage.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.
  • Coached collections team members on best practices.
  • Audited processed claims for accuracy of payment.
  • Maintained 98% or above accuracy level of all reprocessed claims.
  • Maintained compliance with federal, state, and local regulations governing debt collections practices.

Senior Customer Service Supervisor

Carefirst
05.2011 - 10.2012
  • Provided company information and policies to customers upon inquiry and answered questions via phone, or email.
  • Increased customer satisfaction by implementing new strategies to improve service quality and efficiency.
  • Organized meetings for executives and coordinated availability of conference rooms for participants.
  • Led monthly meetings with team, discussing performance metrics and setting goals for continuous improvement.
  • Oversaw recruitment efforts for department, selecting top talent who contributed significantly to team success.
  • Worked on Projects to improve standard operating procedures.
  • Completed bi-weekly payroll for 15 employees

Collections Manager

HSBC Bank
New Castle , Delaware
08.1995 - 03.2011
  • Coached and cancelled a team of 18 senior level collections representatives on a monthly basis.
  • Obtained monthly incentive for at least 24 months contributing to a decrease of 30% in accounts receivables.
  • Exercised leadership capabilities by successfully managing and inspiring a staff of 18 call center representatives.
  • Participated in the Six Signa initiative and was deemed a green belt participant which managed at least three projects per year.
  • Met with Senior Management team to review and analysis the monthly incentive program based on trend analysis and past performance.

Education

BBA - Liberal Arts And General Studies

Wilimington University
Wilmington, DE
07.2021

High School Diploma -

Alexis I. Dupont High School
Greenville, DE
05.1994

Skills

  • Number-savvy
  • Claims Auditing
  • Outstanding clerical abilities
  • Insurance plan verification
  • Medical Billing and Coding Experience
  • Benefits Guidelines
  • Electronic authorization processing
  • Secure data practices
  • EMR Systems
  • Claims Understanding
  • Data Verification
  • Overpayment Identification
  • Analytical Thinking

Timeline

Quality Assurance/Quality Compliance Manager

MV Transportation
06.2022 - Current

Senior Quality Claims Auditor

Cigna
01.2014 - 02.2022

Collections Manager

Sentient Medical
01.2013 - 01.2014

Senior Customer Service Supervisor

Carefirst
05.2011 - 10.2012

Collections Manager

HSBC Bank
08.1995 - 03.2011

BBA - Liberal Arts And General Studies

Wilimington University

High School Diploma -

Alexis I. Dupont High School

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CHARLOTTE HALLEY