Summary
Overview
Work History
Education
Skills
Core Competencies
Timeline
Generic

Jennifer Zorek

NEW CUMBERLAND

Summary

Strategic healthcare operations leader with 20+ years of progressive leadership in revenue cycle management, pharmacy billing and audit, provider enrollment, provider credentialing and medical billing. Expertise in Medicaid/Medicare compliance, credentialing, accounts receivable, and pharmacy operations. Proven success in aligning healthcare revenue strategies with corporate goals, improving billing accuracy, and leading large teams through operational transformations. Adept at building cross-functional partnerships, reducing regulatory risk, and driving system and process efficiencies to enhance financial performance and patient outcomes.

Overview

24
24
years of professional experience

Work History

Director, Health Care Revenue and Enrollment

Rite Aid Corporation
01.2020 - Current
  • Provide strategic leadership and administrative direction for the Company’s Healthcare Revenue Cycle, including billing, collections, provider credentialing, enrollments, accounts receivable, cash management, and customer service.
  • Mentor, develop, and assess revenue cycle managers and staff, ensuring the right skills and training are in place to support company growth into new healthcare revenue channels.
  • Partner with Managed Care, Pharmacy and Clinic Operations, Finance, and external industry partners to align healthcare revenue with corporate strategy.
  • Oversee Medicare Part B, Medicaid, and medical billing enrollments/re-enrollments, ensuring compliance with federal and state regulations.
  • Direct pharmacy claim edits strategies to maintain regulatory compliance and accurate payment processing.
  • Lead Third Party Pharmacy Call Center operations, delivering best-in-class customer service to pharmacy associates.
  • All duties listed as the Sr Manager of Third-Party Industry Relations, Provider Enrollment and Audit (below)

Sr. Manager, Third Party Industry Relations, Provider Enrollment & Audit

01.2011 - 01.2020
  • Directed regulatory compliance for Medicaid and Medicare billing across 4,800+ pharmacy locations, ensuring adherence to payer and state billing requirements while also creating business plans including operational goals, performance targets, compliance targets and implementation of best practices as it relates to pharmacy enrollment, pharmacy billing as well as medical billing in a pharmacy setting.
  • Responsible for examining and interpreting Information from different sources to include both government and legal entities. to develop a course of action in determining the outcome of pending pharmacy audit Issues. Formulate responses to legal Inquires from the DOJ, DEA, Medicare and Medicaid, in conjunction with legal counsel, to mitigate financial exposure
  • Manage a team of individuals responsible for the pharmacy enrollment processes, prescription billing, and immunization billing, reducing audit exposure and financial risk.
  • Manage a team of individuals who maintained the integrity of the pharmacy dispensing prescriber data file and other internal data system files therefor reducing and/or eliminating risk and audit exposure to claims billing.
  • Partner with IT and leadership to implement process improvements that reduced claim rejections and streamlined reimbursement workflows.
  • Oversee vendor relationships to ensure accuracy of claims adjudicating, editing, EDI transactions and timely payments.
  • Oversee and manage the medical billing and collections processes related to pharmacy based clinical services and immunizations. Responsible for business processes and work flow enhancements to centralize the identification correction and research of claims while working with Pharmacy Services, Clinical and IT Management to implement operation changes necessary to reduce claim rejects and overpayment/underpayment from contracted plans.

Manager, Provider Enrollment & Online Adjudication

01.2005 - 01.2011
  • Directed provider enrollment for Medicare, Medicaid, and commercial payers across all pharmacy locations.
  • Developed user guides and process documentation to ensure consistent enrollment practices.
  • Acted as key liaison between clinical operations and third-party payers for immunization billing compliance.
  • Oversaw pharmacy claim submission processes to third-party payers, ensuring compliance with payer contracts.
  • Defined new system requirements and led implementation of billing and claims correction systems.
  • Managed department disaster recovery plan to ensure continuity of operations.

Business Analyst II / Business Analyst

01.2002 - 01.2005
  • Created internal business process documentation, policies, and training materials in compliance with SOX requirements.
  • Conducted compliance risk assessments, identifying control gaps and developing corrective measures.
  • Analyzed pharmacy financial and operational performance, producing reports and ROI studies to support executive decision-making.
  • Partnered with IT and business units to develop system enhancements and improve billing workflows.

Education

Bachelor of Science - Economics

University of Delaware
Newark, DE
06.2001

Skills

  • Microsoft Office Suite (Excel, PowerPoint, Access, Project, Visio, Word)
  • Medicaid/Medicare and Commercial Billing Systems (NCPDP, PECOS, HIPAA EDI 837/835/270/271)
  • Regulatory Compliance: SOX, CMS, HIPAA
  • Fostering collaborative partnerships
  • Goal-oriented planning
  • Collaborative decision-making
  • Team leadership
  • Operational efficiency management
  • Team management
  • Cross-functional project coordination
  • Team leadership
  • Organizational development
  • Effective business planning
  • Program management
  • Oversight of vendor agreements
  • Business growth initiatives
  • Strategic issue analysis
  • Risk mitigation
  • Performance management
  • Continuous process evaluation
  • Strategic vendor partnerships
  • Cross-functional team leadership
  • Sector expertise
  • Workflow refinement
  • Service excellence

Core Competencies

  • Healthcare Revenue Cycle Leadership
  • Provider Enrollment & Credentialing
  • Medicaid/Medicare Compliance
  • Pharmacy & Clinic Operations Support
  • Medical Billing & Accounts Receivable
  • Regulatory Risk Management (SOX, HIPAA)
  • Process Improvement & Technology Integration
  • Strategic Vendor & Partner Relations
  • Staff Development & Organizational Leadership

Timeline

Director, Health Care Revenue and Enrollment

Rite Aid Corporation
01.2020 - Current

Sr. Manager, Third Party Industry Relations, Provider Enrollment & Audit

01.2011 - 01.2020

Manager, Provider Enrollment & Online Adjudication

01.2005 - 01.2011

Business Analyst II / Business Analyst

01.2002 - 01.2005

Bachelor of Science - Economics

University of Delaware

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