Ermite Anicette

Results-driven healthcare operations and quality professional with extensive experience leading quality assurance for Medicare & Medicaid billing, compliance oversight, revenue integrity & staff development within healthcare and insurance environments. Proven ability to manage cross-functional projects, conduct performance audits, improve operational workflow, and collaborate with executive leadership to drive compliance, accuracy, and organizational performance. Strong background in Medicare, Medicaid, HEDIS, claims adjudication, training development, analytics, and regulatory compliance.

Quality Assurance Specialist at Performant Healthcare/CMS (2018-01 – 2026-04)

Update SOPs for improvement, review audits for appeals, monitor reports for discrepancies. Review ICD 10 coding, and Medicare billing compliance in alignment with CMS regulations and organizational standards. Reach out to Case Workers to provide feedback on quality measures monthly for CMS and provide training as necessary, Verified Medicare entitlement coverage, managed audit reporting, compliance tracking, and trend analysis to identify operational gaps and implement corrective actions.

Prepared audit reports, presentations, and performance summaries for leadership review. Provided ongoing coaching, training, and performance feedback to staff to improve billing accuracy, compliance adherence, and operational efficiency. Partnered with CMS representatives and internal leadership teams to support audit readiness, policy implementation, and continuous process improvement initiatives.

Develop and update job aids, SOPs, and workflow documentation to support operational consistency and regulatory compliance.

Revenue Integrity & Billing Specialist at Conifer Health (2015-05 – 2017-07)

Medical billing & collection. Supported revenue cycle initiatives across multiple hospital systems by ensuring compliant and accurate billing operations. Screen and evaluate patients for existing Medicaid coverage, review invoices and charts as needed based on client's concerns.

Ensure all insurance, demographic and eligibility information is entered into the system. Document the patient's account with pertinent data relating to the reason for the call. Process charity/ discounts approval reported by the hospital.

Provide billing statements to all Florida facilities to help meet the Medicaid Shared Cost.

Report

Issues identified as internal processing problem, incorrect patient billed, erroneous demographic and insurance information to the client service manager. Review correspondence from patients, Letter of Disputes (LOD's) EOB's Research and provide recommendations to the Reimbursement, trained & mentored staff on Medicaid billing procedures, data entry, appeals processing, and regulatory compliance standards. Conducted reporting analysis and audit reviews to identify discrepancies, improve operational performance, and reduce revenue leakage.

Sr.

Patient

Advocate at TMS Health (2012-06 – 2015-05)

Served as lead liaison for escalated patient concerns, billing disputes, and insurance verification. Obtain relevant medical evidence for discounted diabetic coverage, registered approved diabetic patients for insulin supply, reported adverse events to the FDA. Coordinated communication between patients, providers, pharmacists, and compliance teams to ensure timely issue resolution.

Educated nurses, and healthcare professionals on diabetic devices, insurance coverage, and patient support processes.

Patient Advocacy Specialist at Aetna RX Pharmacy Medicare (2008-05 – 2012-02)

Managed Medicare Medicare Part D claims adjudication and insurance coverage reviews while ensuring compliance with regulatory guidelines. Provide patient outreach to identify gaps in coverage, and medication fulfillment. Educate patients & providers on preventive care measures and schedule screenings.

Assisted patients and pharmacies with complex insurance coverage issues, prior authorizations, co-pays, and medication access solutions. Complete overrides on medication fulfillment for pharmacies. Processed pharmacy mail orders, verify insurance registration & enrollment.

Provided administrative and general customer service support.

– Lynn University