Timothy Rising Jr.
Forney,Texas
Summary
Analytical and detail-oriented healthcare professional with 5+ years of experience in medical documentation review, appeals analysis, and compliance oversight across public and private healthcare systems. Proven ability to ensure accuracy, adherence to regulatory requirements, and data integrity while supporting program performance and audit readiness. Skilled in identifying discrepancies, collaborating with medical professionals, and maintaining productivity and quality metrics in fast-paced environments.
Overview
13
13
years of professional experience
Work History
Healthcare Quality and Compliance Analyst
Freedomcare Healthcare Organization
01.2025 - 10.2025
- Partner with cross-functional teams to document and refine standard operating procedures (SOPs) that align with internal policy, HIPAA, and state/federal requirements.
- Conduct quality assurance reviews of patient documentation and care management data to ensure compliance with federal and state healthcare requirements.
- Evaluate and verify medical and service documentation for completeness, accuracy, and alignment with organizational and legal standards, including HIPAA.
- Collaborate with internal and external healthcare professionals to resolve documentation discrepancies and clarify medical information to support accurate case records.
- Monitor documentation workflows and compliance metrics, preparing detailed reports for leadership highlighting quality trends, risks, and audit outcomes.
- Supported audit readiness and process improvement initiatives by revising SOPs and compliance checklists in alignment with new program policies.
- Consistently met and exceeded productivity and quality standards for case documentation review and submission.
- Safeguarded personally identifiable and protected health information (PII/PHI) in accordance with confidentiality standards.
- Proven experience reviewing and verifying medical exam documentation for compliance with legal and clinical standards.
- Strong understanding of healthcare terminology, documentation integrity, and information governance.
- Communicated regularly with payer representatives, healthcare providers, and internal teams to ensure efficient case resolution and prompt payment.
- Maintained accurate tracking systems for appeals, claims, and follow-up actions to ensure deadlines were met and data integrity was preserved.
Educator
Duval County Public Schools
Jacksonville, FL
10.2019 - 07.2024
- Developed and implemented dynamic lesson plans aligned with Florida state and national history standards, focusing on critical thinking and historical analysis.
- Created a variety of instructional materials, including lectures, interactive activities, and assessments tailored to diverse learning styles and student needs.
- Tracked performance data to ensure adherence to institutional standards and compliance requirements.
- Utilized differentiated instruction techniques to support students with varying abilities and learning preferences.
- Integrated diverse historical perspectives and current research into curriculum materials to promote inclusivity and accuracy.
- Collaborated with teaching teams to share best practices and enhance instructional strategies across grade levels.
- Actively participated in professional development programs to stay current with educational trends, curriculum updates, and innovative teaching practices.
Medical Documentation Federal Appeals Review Analyst
TMF Health Quality Institute (C2C Innovative Solutions Inc)
Jacksonville, FL
01.2015 - 10.2019
- Managed complex appeals and compliance reviews for federal and state healthcare programs, ensuring adherence to ERISA and HIPAA regulations.
- Developed documentation protocols and data management processes that improved accuracy and audit readiness across multiple healthcare contracts.
- Compliance teams to streamline reporting workflows and automate appeal tracking and validation systems.
- Collaborated on regulatory submissions and documentation updates supporting internal audits and federal quality initiatives.
- Created and maintained risk assessment reports and post-implementation analysis to evaluate policy efficiency and compliance outcomes.
- Provided insights on healthcare quality metrics to internal leadership and external clients to guide operational strategy and legal decision-making.
- Maintained confidential patient and provider data in compliance with federal privacy and data protection standards.
- Researched and acquired all necessary supporting documentation to strengthen appeal cases, ensuring completeness and accuracy before submission to payers and review boards.
- Conducted in-depth analysis of claim payments to verify reimbursement compliance with state and federal fee schedules, including VA and government-funded programs.
- Developed appeal packets and correspondence to support reimbursement recovery, utilizing analytical data and historical claim information to build strong case documentation.
Business Support Analyst
ADT
Jacksonville, FL
10.2013 - 01.2015
- Reviewed, processed, and verified high volumes of residential and commercial security contracts for accuracy, completeness, and compliance with ADT policies and legal standards.
- Ensured timely and accurate data entry of customer information, service terms, and payment details into CRM and billing systems.
- Collaborated with sales teams, technicians, and customer service departments to resolve discrepancies and ensure all documentation was submitted correctly.
- Performed quality control checks to ensure contracts met internal requirements and state/federal regulations.
- Maintained detailed and organized records of all processed contracts in accordance with company retention policies.
- Responded promptly to internal inquiries related to contract status, billing setup, and compliance issues.
- Utilized ADT’s internal systems and platforms to track contract progress and update records in real-time.
- Participated in audits and process improvement initiatives to streamline contract processing workflows and reduce errors.
- Ensured customer confidentiality and protected sensitive personal and financial information in compliance with data protection standards.
Assistant Manager
Walgreens
Tallahassee, FL
05.2012 - 07.2013
- Supervised, trained, and coached team members to ensure high performance, strong customer engagement, and adherence to Walgreens’ customer service standards.
- Ensured proper scheduling and labor management to meet business needs and payroll targets.
- Maintained store appearance, cleanliness, and adherence to visual merchandising guidelines.
- Resolved escalated customer issues with professionalism, maintaining satisfaction and loyalty.
- Monitored key performance indicators (KPIs) including sales goals, shrink, customer service scores, and pharmacy performance metrics.
- Supported pharmacy operations by ensuring front-end compliance with health regulations, HIPAA, and store safety procedures.
- Conducted daily audits and ensured accountability in cash handling, deposits, and till reconciliations.
- Participated in loss prevention efforts and maintained accurate records of inventory, returns, and damages.
- Assisted in onboarding new hires and fostering a positive, inclusive work environment aligned with Walgreens’ mission and values.
Education
Bachelor of Science - Political Science
Florida A&M University
Tallahassee, FL07.2010
Skills
Healthcare
Project Management Tools: MS Project, Smartsheet, Asana, Jira
Methodologies: Waterfall, Agile, Lean
Compliance & Regulations: HIPAA, CMS, Joint Commission Standards
Communication: Executive Reporting, Stakeholder Engagement, Change Management
Microsoft Project – For creating detailed project plans and timelines
Smartsheet –For managing large-scale workflows and timelines
Jira – Utilized in company EHR software development projects
Confluence – Documentation and team collaboration
Microsoft Teams / Slack / Zoom – Communication and virtual team collaboration
SharePoint – Document management and internal collaboration
Case Management & Claims Systems: QNXT, Facets, HealthEdge, Epic Tapestry, PowerMHS
Electronic Medical Records (EMR/EHR): Epic, Cerner, Allscripts, Meditech, HL7 SIU,ADT, HIPAA X12 837
Appeals Tracking and Workflow Tools: Salesforce Health Cloud, Pega, OnBase by Hyland
Regulatory Research & Submission Portals: CMS Enterprise Portal, MAC portals (eg, Noridian, Novitas), QIC Appeals Portal, HHS OHA (OMHA e-Appeal)
Document Management & Productivity Tools: Microsoft Office Suite, SharePoint, Adobe Acrobat Pro, DocuSign
Activities
Literature, Film, Art, Working-out, Football, Travel
Clinical Shadowing Experience
- Under Physician Assistant – Emergency Medicine
- University of Florida Health – Shands Jacksonville Hospital, Jacksonville, FL
- Dates of Experience: May 2013 – July 2017
- Completed clinical shadowing under a certified Physician Assistant in a high-acuity emergency department at a Level I trauma center.
- Observed patient assessment, triage, and medical decision-making processes for a wide variety of emergency cases, including trauma, cardiac, neurological, and pediatric emergencies.
- Gained exposure to diagnostic procedures, imaging review, wound care, and treatment planning.
- Learned to navigate the fast-paced environment of emergency medicine while understanding interdisciplinary teamwork among physicians, nurses, and allied health professionals.
- Observed use of electronic health records (EHR) and compliance with HIPAA and hospital protocols.
- Developed foundational knowledge in patient communication, critical thinking, and procedural workflows in emergency care.
Timeline
Healthcare Quality and Compliance Analyst
Freedomcare Healthcare Organization
01.2025 - 10.2025
Educator
Duval County Public Schools
10.2019 - 07.2024
Medical Documentation Federal Appeals Review Analyst
TMF Health Quality Institute (C2C Innovative Solutions Inc)
01.2015 - 10.2019
Business Support Analyst
ADT
10.2013 - 01.2015
Assistant Manager
Walgreens
05.2012 - 07.2013
Bachelor of Science - Political Science
Florida A&M University