Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Eventhea (Eve) Bufi

Boonton

Summary

Results driven healthcare professional with 15 years of experience in managed care analysis, reimbursement methodologies, and leadership. Demonstrated expertise in contract evaluation, claims analysis, and identifying revenue opportunities. Skilled in contract interpretation, complex reimbursement structures, collaborating cross-functionally to enhance overall operations, and driven results by detailed data analysis and reporting.

Overview

16
16
years of professional experience
1
1
Certification

Work History

Manager, Payment Variance

Med-Metrix
Parsippany, NJ
01.2022 - Current
  • Oversee daily operations for the Payment Variance Services team, including work assignment distribution, inventory management, and monitoring of aging inventory.
  • Ensure timely and accurate resolution of underpayments, payer disputes, and variance items in accordance with client and departmental performance standards.
  • Serve as the primary escalation contact for complex underpayment recovery scenarios.
  • Present payer behavior trends, billing issues, and process gaps to clients, offering recommendations for workflow improvements or client-side procedural changes.
  • Work closely with cross-functional teams (HB AR, PB, Contract Management, Business Intelligence, and Client Services) to ensure alignment on payer issues impacting AR or reimbursement.
  • Maintain up-to-date knowledge of payer rules, reimbursement methodologies, underpayment denial patterns, and policy changes impacting Med-Metrix clients.
  • Identify payer, billing, and operational trends that require process adjustment, escalation, or client intervention
  • Support continuous improvement initiatives to enhance recovery performance, reduce avoidable variances, and streamline internal processes.
  • Developed and implemented strategic initiatives to improve patient engagement and satisfaction.
  • Managed performance metrics, ensuring alignment with organizational goals and standards for Payment Variance
  • Handle all month end invoicing

Supervisor, Payment Variance

Med-Metrix
Parsippany, NJ
06.2018 - 01.2022
  • Supervised daily payment variance operations, ensuring compliance with healthcare regulations and standards.
  • Implemented Payer Trend reporting for active clients, including participation in JOC calls to handle trends or escalations
  • Lead succession planning incentive to promote analysts
  • Developed performance metrics to evaluate staff productivity and operational effectiveness.
  • Increased team productivity by implementing efficient workflow system
  • Collaborated with other departments to achieve organizational goals

Supervisor Managed Care Analysis

nThrive
05.2015 - 06.2018
  • Review claim & payment data through contract management systems to identify potential individual underpayments and underpayment trends.
  • Ensure contract systems are accurately updated with applicable rates/terms & assist with the modeling of schemes and auditing calculations of the contract profile(s).
  • Review hospitals managed care contracts to determine appropriate application of rates, provisions and terms in comparison to reimbursement received.
  • Calculation validation (Proration of contractual rates) in hospital patient account system
  • Analysis contract analysis to provide feedback surrounding improvement areas in current contract terms for future contract negotiations.
  • Educates the Managed Care Analysis team and acts as a knowledge and experience resource for the department. Create & provide training documents, Providing One on One time with analysts.
  • Maintains personal knowledge base of current managed care trends, reimbursement methodologies, and other important third party payment factors
  • Tracks team progress according to defined metrics.
  • Provides client contract specific feedback, intelligence, and trends to Directors for regularly scheduled client calls and meetings.
  • Interfaces with Director of Managed Care Analysis to ensure that recovery analyst team maintain priorities and meet established departmental goals.

Lead Managed Care Analyst

nThrive
10.2014 - 05.2015
  • Review claim and payment information through contract management and underpayment identification systems to identify potential individual underpayments and underpayment trends.
  • Review hospitals managed care contracts to determine appropriate application of rates, provisions and terms.
  • Analysis of use of variance reports to review potential missed underpayment opportunities.

Contract Underpayment Recovery Analyst

nThrive
04.2012 - 10.2014
  • Review claim and payment information through contract management and underpayment identification systems to identify potential individual underpayments and underpayment trends.
  • Review hospitals managed care contracts to determine appropriate application of rates, provisions and terms.
  • Makes use of high volume reports to review historical payment information and determine the accuracy of reimbursements.
  • Identifies potential underpayment trends through comparison of managed care contracts to actual reimbursement information via contract management technology.
  • Investigates third party payer policies and contracts to verify accuracy of underpayment variances according to published payer guidelines.

Medicaid Supervisor

nThrive
08.2010 - 04.2012
  • Oversee the day to day supervision of a team of Patient Account Representatives
  • Act as a technical expert in regards to financial class responsibility, to answer questions raised by clients and team members in regards to reimbursement methodologies (APR DRG, facility rate based reimbursement)
  • Analyze & report any detected trends in payments or denials, as well as procedural problems, to the client. Provide recommendations regarding the correction of these trends and/or problems should also be reported.
  • Daily quality assurance auditing on patient account representatives
  • Maintain a current working knowledge of all healthcare related issues and regulations
  • Prepare various reports or logs as required: cash reports, denial reports, trending/issue reports
  • Knowledge of governmental, legal and regulatory provisions related to collection activity.

Education

Health Sciences -

Bergen Community College
Paramus, NJ
08-2007

Skills

  • Proprietary Contract Management systems, Proration validation
  • Claims EDI Software: SSI, FinThrive Claims Management,
  • 3M Grouping Software (APR DRG grouping)
  • Various patient accounting systems: EPIC, Meditech, STAR, EAGLE, Expanse, Cerner
  • Microsoft Excel – Advanced Formulas
  • Team leadership
  • Time management
  • Decision-making
  • Complex Problem-solving
  • Staff training and development
  • Staff management
  • Task delegation
  • Cross-functional teamwork

Certification

  • HFMA Certified Revenue Cycle Representative
  • June 2015

Timeline

Manager, Payment Variance

Med-Metrix
01.2022 - Current

Supervisor, Payment Variance

Med-Metrix
06.2018 - 01.2022

Supervisor Managed Care Analysis

nThrive
05.2015 - 06.2018

Lead Managed Care Analyst

nThrive
10.2014 - 05.2015

Contract Underpayment Recovery Analyst

nThrive
04.2012 - 10.2014

Medicaid Supervisor

nThrive
08.2010 - 04.2012

Health Sciences -

Bergen Community College

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