Professional in Information Systems
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Provides oversight, guidance and workflow of all Health Information Management staff in the main HIM area.
Accepts responsibility and accountability for operations of assigned functional areas in the.
Director's absence Identifies and implements changes regarding policy, productivity and quality measures, and assures that staff performance improvements related to work-flow efficiencies and operations.
In coordination with the Director of Health Information Management, recruits, interviews and makes recommendations to fill personnel vacancies Coordinates staffing issues and procedural issues with Director of Heath Information Management In coordination with the Director of Health I
Information Management, evaluates staff performance on an annual basis. Accurately measures and evaluates staff performance, productivity and quality measures, and assures that staff is following and meeting departmental standards In coordination with the Director of Health Information Management, trains, provides feedback, evaluates and provides corrective action to staff as needed Responds to inquiries of staff, vendors and the public for the purpose of providing information and/or direction, discussing and resolving any issues and/or problems Ensures staff maintain a positive customer service attitude Prepare, Oversees and approves work schedules Covers the schedule for call-ins on a daily basis Verification and approval of time cards
July 2022 to August 2023
Spearheaded the development and enhancement of mission-critical applications, collaborating closely with technical support staff and software engineers to ensure seamless integration and optimize performance in alignment with cybersecurity best practices.
Presented comprehensive findings and recommendations to senior management, empowering informed decision-making and strategic planning for IT projects with a focus on cybersecurity and healthcare administrative needs.
Applied comprehensive knowledge of the NIST Cyber Security Framework (CSF) and associated best practices to assess and enhance the security posture of healthcare
IT systems, identifying potential risks and implementing appropriate safeguards.
Played a pivotal role in integrating Okta identity and access management solutions with various applications and systems, establishing seamless user authentication, authorization, and user lifecycle management processes across the healthcare environment.
Leveraged scripting and programming skills in languages such as PowerShell,
Bash/Shell, Python, and Go to automate system tasks, streamline workflows, and develop cloud-native services and applications, enhancing operational efficiency and security.
Maintained an up-to-date understanding of emerging cybersecurity threats, cloud-based infrastructure advancements, and software defined networks, implementing proactive measures to safeguard healthcare systems and mitigate potential risks effectively.
April 2018 to September 2022
Conducting thorough verification of Medicare, Medicaid, and Commercial Insurance for Outpatient Rehab Therapy and Perinatal services, prioritizing data privacy and cybersecurity protocols.
Utilizing the Cerner platform to document and track changes in patient's health insurance coverage and eligibility for benefits, ensuring accurate and secure information management. Leveraging a wide range of healthcare portals, including Passport, Core MMIS, IU
Health, Availity, CMS website, and others, to perform benefit verification tasks such as assessing out-of-pocket expenses, co-pays, deductibles, and other financial details, while adhering to stringent cybersecurity measures.
Proactively engaging in pre-registering patients over the phone, meticulously reviewing and updating their healthcare records to guarantee data accuracy and completeness ahead of scheduled outpatient appointments.
Demonstrating expertise in financial clearance processes, diligently confirming that patients' health insurance or self-payment methods covered the cost of healthcare services and ensuring timely acquisition of necessary authorizations for procedures or healthcare services, thereby bolstering financial and operational security.
April 2020 to January 2021
January 2006 to January 2009
Oversaw and managed the Medicaid and Medicare billing processes, leveraging an in-depth knowledge of HCFA 1500 forms.
Implemented efficient billing procedures, resulting in improved accuracy and reduced claim rejections.
Performed diligent follow-up on Medicare and Medicaid claims, resolving discrepancies and ensuring timely reimbursement.
Conducted regular audits of billing documentation to identify errors or inconsistencies, taking corrective actions to maintain compliance. Acted as a liaison between the healthcare organization and government agencies, maintaining up-to-date knowledge of Medicaid and Medicare policies and guidelines.
Developed and delivered training programs for staff members to enhance their understanding of Medicaid and Medicare billing procedures.
Demonstrated strong attention to detail in analyzing data sets, identifying anomalies, and implementing corrective measures to maintain data integrity.
Provided exceptional customer service by addressing inquiries and concerns related to data quality, ensuring a high level of customer satisfaction.
Generated weekly and monthly health quality reports for monitoring and tracking data quality metrics, identifying trends, and making data-driven recommendations.
Worked closely with other administrative, supervisory, and management personnel to meet CMS standards for patient quality care through comprehensive reporting, monitoring, documentation, and follow-up.
Successfully managed a team of employees, both remotely and onsite, providing guidance, support, and training to ensure adherence to data quality standards.
Maintained strict confidentiality of all sensitive information, adhering to HIPAA regulations and cybersecurity protocols to protect patient data and organizational assets.
January 2012 to December 2015
ICD-10
Provides oversight, guidance and work flow of all Health Information Management staff in the main HIM area.
Accepts responsibility and accountability for operations of assigned functional areas in the.
Director's absence Identifies and implements changes regarding policy, productivity and quality measures, and assures that staff performance improvements related to work-flow efficiencies and operations.
In coordination with the Director of Health Information Management, recruits, interviews and makes recommendations to fill personnel vacancies Coordinates staffing issues and procedural issues with Director of Heath Information Management In coordination with the Director of Health I
Information Management, evaluates staff performance on an annual basis. Accurately measures and evaluates staff performance, productivity and quality measures, and assures that staff is following and meeting departmental standards In coordination with the Director of Health Information Management, trains, provides feedback, evaluates and provides corrective action to staff as needed Responds to inquiries of staff, vendors and the public for the purpose of providing information and/or direction, discussing and resolving any issues and/or problems Ensures staff maintain a positive customer service attitude Prepare, Oversees and approves work schedules Covers the schedule for call-ins on a daily basis Verification and approval of time cards
July 2022 to August 2023
Spearheaded the development and enhancement of mission-critical applications, collaborating closely with technical support staff and software engineers to ensure seamless integration and optimize performance in alignment with cybersecurity best practices.
Presented comprehensive findings and recommendations to senior management, empowering informed decision-making and strategic planning for IT projects with a focus on cybersecurity and healthcare administrative needs.
Applied comprehensive knowledge of the NIST Cyber Security Framework (CSF) and associated best practices to assess and enhance the security posture of healthcare
IT systems, identifying potential risks and implementing appropriate safeguards.
Played a pivotal role in integrating Okta identity and access management solutions with various applications and systems, establishing seamless user authentication, authorization, and user lifecycle management processes across the healthcare environment.
Leveraged scripting and programming skills in languages such as PowerShell,
Bash/Shell, Python, and Go to automate system tasks, streamline workflows, and develop cloud-native services and applications, enhancing operational efficiency and security.
Maintained an up-to-date understanding of emerging cybersecurity threats, cloud-based infrastructure advancements, and software defined networks, implementing proactive measures to safeguard healthcare systems and mitigate potential risks effectively.
April 2018 to September 2022
Conducting thorough verification of Medicare, Medicaid, and Commercial Insurance for Outpatient Rehab Therapy and Perinatal services, prioritizing data privacy and cybersecurity protocols.
Utilizing the Cerner platform to document and track changes in patient's health insurance coverage and eligibility for benefits, ensuring accurate and secure information management. Leveraging a wide range of healthcare portals, including Passport, Core MMIS, IU
Health, Availity, CMS website, and others, to perform benefit verification tasks such as assessing out-of-pocket expenses, co-pays, deductibles, and other financial details, while adhering to stringent cybersecurity measures.
Proactively engaging in pre-registering patients over the phone, meticulously reviewing and updating their healthcare records to guarantee data accuracy and completeness ahead of scheduled outpatient appointments.
Demonstrating expertise in financial clearance processes, diligently confirming that patients' health insurance or self-payment methods covered the cost of healthcare services and ensuring timely acquisition of necessary authorizations for procedures or healthcare services, thereby bolstering financial and operational security.
April 2020 to January 2021
January 2006 to January 2009
Oversaw and managed the Medicaid and Medicare billing processes, leveraging an in-depth knowledge of HCFA 1500 forms.
Implemented efficient billing procedures, resulting in improved accuracy and reduced claim rejections.
Performed diligent follow-up on Medicare and Medicaid claims, resolving discrepancies and ensuring timely reimbursement.
Conducted regular audits of billing documentation to identify errors or inconsistencies, taking corrective actions to maintain compliance. Acted as a liaison between the healthcare organization and government agencies, maintaining up-to-date knowledge of Medicaid and Medicare policies and guidelines.
Developed and delivered training programs for staff members to enhance their understanding of Medicaid and Medicare billing procedures.
Demonstrated strong attention to detail in analyzing data sets, identifying anomalies, and implementing corrective measures to maintain data integrity.
Provided exceptional customer service by addressing inquiries and concerns related to data quality, ensuring a high level of customer satisfaction.
Generated weekly and monthly health quality reports for monitoring and tracking data quality metrics, identifying trends, and making data-driven recommendations.
Worked closely with other administrative, supervisory, and management personnel to meet CMS standards for patient quality care through comprehensive reporting, monitoring, documentation, and follow-up.
Successfully managed a team of employees, both remotely and onsite, providing guidance, support, and training to ensure adherence to data quality standards.
Maintained strict confidentiality of all sensitive information, adhering to HIPAA regulations and cybersecurity protocols to protect patient data and organizational assets.
January 2012 to December 2015
ICD-10
Masters in Health Information Management
