FREDA HARPER
Portsmouth,VA
Summary
Healthcare operations professional with extensive experience in provider configuration, data management, and claims processing. Proven track record of improving payment accuracy and validating provider agreements while ensuring compliance with HIPAA privacy standards. Strong analytical skills and collaborative approach support efficient healthcare operations.
Overview
12
12
years of professional experience
Work History
Direct Support Professional
Cre8FORLIFE, LLC
Norfolk, VA
02.2025 - Current
- Transported individuals to appointments and community activities, enhancing participation and fostering independence.
- Administer medications and document services in accordance with established procedures and safety protocols.
- Maintained accurate progress documentation, ensuring compliance with individualized care plans and reporting requirements.
- Supported daily living activities, promoting independence and encouraging informed decision-making.
- Maintain safe environments and provide support based on individual needs and established care plans.
Configuration Analyst II
Anthem / Elevance Health
Norfolk, VA
01.2015 - 04.2024
- Developed and executed test claims to validate configuration, pricing, and expected adjudication results before implementation.
- Configured provider and facility network agreements in Facets NetworX using the Medical Agreement Configurator to support accurate claims processing and reimbursement.
- Conducted daily audits of provider and facility contracts, validating reimbursement rates and fee schedules to ensure configuration accuracy and compliance with industry standards.
- Reviewed claims for pricing and configuration discrepancies, researched root causes, and facilitated corrective actions to enhance payment accuracy.
- Generated claims reports in Microsoft Access to verify network assignments and provider agreement configurations, ensuring compliance with reimbursement protocols.
- Collaborated with IT, Operations, and business stakeholders to investigate system issues and resolve configuration-related processing problems.
- Researched state reimbursement files for hospitals, Rural Health Clinics, and Federally Qualified Health Centers to identify applicable rates and implement updates.
- Supported quality assurance activities by validating provider records, network assignments, pricing rules, and claims outcomes.
Provider Data Management | Provider Services | Member Services | Configuration
AMERIGROUP CORPORATION
Virginia Beach, VA
01.2015 - 04.2024
- Managed and validated provider demographic and participation data, ensuring accuracy of provider records to enhance member access to healthcare services.
- Provided Provider Services support by assisting providers with network, demographic, participation, and administrative inquiries.
- Advanced to Configuration Analyst, assigning pricing agreements to provider records to facilitate accurate claims adjudication.
- Reviewed 20+ provider contracts daily to ensure compliance with reimbursement rates and optimize pricing configurations in Macess.
- Evaluated claims for pricing and valuation errors and documented findings for corrective action.
- Established and maintained agreements for Rural Health Clinics and Federally Qualified Health Centers to support accurate claims processing.
- Supported Member Services by responding to member inquiries, researching provider and account information, and assisting with issue resolution.
- Progressed through multiple healthcare operations functions, gaining experience in member support, provider services, provider data management, claims, pricing, and configuration.
- Applied HIPAA privacy and confidentiality requirements when handling protected health information (PHI).
Education
Bachelor of Science (B.S.) - Accounting
Norfolk State University
Norfolk, VASkills
- Patient support
- Care plan implementation
- Service documentation
- Care quality monitoring
- Provider data management
- Issue resolution
- Customer service and support
- HIPAA compliance and privacy
- PHI management
- Electronic chart management
- Cross-functional teamwork
- Professional communication skills
Timeline
Direct Support Professional
Cre8FORLIFE, LLC
02.2025 - Current
Configuration Analyst II
Anthem / Elevance Health
01.2015 - 04.2024
Provider Data Management | Provider Services | Member Services | Configuration
AMERIGROUP CORPORATION
01.2015 - 04.2024
Bachelor of Science (B.S.) - Accounting
Norfolk State University