C Robinson
Results-driven healthcare operations professional
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About
Results-driven healthcare operations professional with deep expertise in research, analysis, and decision-making in highly regulated environments. Demonstrated success in Medicare operations, business analysis, call center technology, vendor management, and healthcare compliance. Known for enthusiasm, determination, and tenacity, with proven leadership experience driving process improvements, operational excellence, and high-performing teams.
Experience
EDI Analyst I - First Coast Service Options, Inc. - Jacksonville, FL
(2014-11)
Provide analytical and technical support to Medicare providers, vendors, and clearinghouses through the Electronic Data Interchange (EDI) Help Desk.
- Review and validate incoming Direct Data Entry (DDE) enrollment request for Medicare providers, ensuring accurate user provisioning, enrollment tracking and timely system access.
- Prepare and process Administrative Simplification Compliance Act (ASCA) monthly and quarterly reports for leadership review.
- Mentor provider offices, trading partners, clearinghouses, and billing services on EDI issues and resolution strategies.
- Identify, analyze, and report system issues related to EDI products, including PC-Ace Pro 32, PC Print, Electronic Remittance Advice (ERA), and ANSI ASC X12 transactions (837P, 837I, 835, 270/271, 276/277).
- Analyze Medicare FISS/MCS and related claims systems to assess provider data quality and regulatory compliance with HIPPA and CMS Standards.
Operations Analyst III - First Coast Service Options, Inc. - Jacksonville, FL
(2005-09 - 2014-11)
- Led high-performing teams and conducted quality audits to support compliance, ethics, and integrity in alignment with CMS regulatory requirements.
- Reported, managed, and analyzed operational data to support business requirements and executive decision-making.
- Participated in senior-level meetings, providing strategic input and recommendations to leadership and client stakeholders.
- Conducted root cause analysis to resolve client issues and improve business processes through data interpretation and trend analysis.
- Supported testing initiatives for client service conversions and implementation of new audits and system edits.
- Mentored new Operations Analysts on departmental policies, procedures, and core applications to support effective performance and compliance.
- Researched and analyzed written and verbal requests related to Medicare Part A and B fraud investigations.
- Developed Standard Operating Procedures (SOPs) based on federal regulations and Joint Operating Agreements (JOA).
- Generated and delivered monthly savings reports to the Zone Program Integrity Contractor (ZPIC) for CMS tracking.
- Assisted with the transition from ICD-9 to ICD-10 coding systems.
- Served as a subject matter expert on process flow changes between First Coast Service Operations and ZPIC.
Senior Collection Specialist - Blue Cross Blue Shield of Florida - Jacksonville, FL
(2003-01 - 2005-09)
- Led a high-performing team and conducted financial audits to ensure Medicare compliance with federal regulations.
- Researched and analyzed written and telephone inquiries from Medicare providers to recover funds owed to the Medicare program.
- Developed Standard Operating Procedures (SOPs) in accordance with CMS regulations.
- Analyzed, documented, and reconciled financial data for provider enrollment and CMS reporting.
- Prepared quarterly cost-savings reports for the Accounts Receivable department.
- Educated Medicare providers, attorneys, and consultants on federal laws governing the Medicare program through written and verbal communication.
Education
Bachelor's degree - Healthcare Administration - University of North Florida
Certificate - Leadership Development Program - First Coast Service Operations
