Business Analyst/Security Analyst

                                                                                             EVELIA LYNN MILLARD, CPC                                           

7202 Lancaster Loop NE

Atlanta, GA 30328

(H) 770-481-0573 * (C) 678-641-6012

eveliamillard@gmail.com

 

EDUCATION                                                                                                                                                                                                                         

 

                                WAYLAND BAPTIST UNIVERSITY, Anchorage, AK                                                                       1996-1999/2011-2012

                                Bachelor of Business Administration Specializing in Healthcare Administration

                               

                                COLLEGE OF ST SCHOLASTICA, Duluth, MN (Online program)                                                                2012-

                                Attending to receive Masters in Health Information Management (no degree yet)                             

 

CERTIFICATIONS                                                                                                                                                                                                                

 

  • Certified Professional Coder (CPC), American Academy of Professional Coders (AAPC) 
  • Certificate in Medical Terminology
  • Certified Nursing and Home Health Assistant

 

EXPERIENCE                                                                                                                                                                                                                        

 

Xerox Company, Government Healthcare Solutions, Atlanta, GA                                                                             Feb. 2013-Present

Medicaid Systems Development Security Business Analyst in MMIS System                                                                                         

  • Performs detailed gap analysis between client requirements and base system design, to identify areas for potential  

modification or enhancement related to MMIS (Medicaid Management Information System) security

  • Manages the system security and role privilege matrix requirements in MMIS System 
  • Serves as liaison between the customer and the development team for business analysis activities 
  • Assists with managing client expectations; provides clear, concise and timely communication and support to customers throughout the development lifecycle.  
  • Ensures that project deliverables conform to QA and contractual requirements and that all project standards are met 
  • Develops and maintains Business and Use Cases
  • Serves as Subject Matter Expert (SME) for the development team during construction and unit testing
  • Assists with the development of System Test Plan; develops system test cases, scripts and system test data;
  • Uses automated testing tools where appropriate; executes system test plan; analyzes results; documents and manages defects
  • Coordinates defect resolution with developers and retests resolved defects
  • Develops customer deliverables, including Requirements Validation Specification documents, General System Design documents and Detailed System Design documents
  • Provides on-site support of customer during implementation activities
  • Provides issue resolution recommendations to project managers for each project.
  • Ensure that there is regular and effective communications of issues and corrective actions between teams
  • Participates in the Issue Tracking procedures, and serve as gatekeeper of the issues.
  • Make  customized changes to the MMIS per state guidelines and client request
  • Managed security access into MMIS for clients as well as staff
  • Created new security reports and maintained other security reports within MMIS system
  • Reporting using SQL for different Query reporting
  • Created queries within IBM Rational Clear Quest

 

iHEALTH TECHNOLOGIES, Atlanta, GA                                                                                                                          Feb. 2007 – Feb. 2013

Sr. Research Analyst/ Business Analyst/Coding review/Medicare & Medicaid Fee Schedule Process Manager

Business Analyst & Project Team Lead designing/testing new software for managing Medicare Fee Schedule

  • Lead analyst for Medicare and Medicaid Updates and other Industry Updates (ASC, CCI, OCE, CPT, ICD, HCPCS)
  • Payment Policy Management for clients to reduce medical expenses
  • Create logic rules and edits for clients to ensure correct coding for Medicare, Medicaid and commercial insurance
  • Assist in new software applications development and implementation projects
  • Developed new Medical policies based off CMS, AMA, CCI and other core logics.
  • Managed/Tested Abstract Rule Development project
  • Providing information to team to help streamline Automation of Medicare Fee Schedule
  • Configured rules according to how logic is to edit.
  • User Testing for New software created to improve operational effiency
  • Assisted with Building new system from beginning to end
  • Creating tables and spreadsheets
  • Researched new Medicare and Medicaid potential rule logics per state guidelines
  • Review RVU files for Medicare and Medicaid
  • Assist in the development and maintenance of operating policies and procedures for Medical Policy Research
  • Trained in ICD-10 rule development
  • Researched and responded to client inquires and adjudication issues
  • Ensured that the client’s chosen rule set was implemented based on decision and needs
  • Presented new or updated policies to client for review and acceptance
  • Assist in automating systems and serving as Medicare Expert on team
  • Chosen as one of the Subject Expert Matter Representatives for projects like Rule Update, Power Flow, and UAT.
  • Ensure that each client initially chosen rule set has been implemented accurately based on the client decision
  • Review rules and organize them so that they can be presented to clients based on specific rule configuration consideration.
  • Perform post-payment coding audits to ensure no overpayment and correct coding regulations were followed
  • Provide general client support for claim adjudication questions.
  • Document upkeep related to the client rule set.
  • Research claims and denials so that correct adjudication is made.
  • Create and run report to assist in the financial savings for the client.
  • Research CMS website to assure rules are correct in presenting to client.
  • Served as Lead and performed training for new staff as well as others needing assistance
  • Product software tester for new changes implemented.
  • Performed audits on work to insure less errors
  • Created policies at the request of the client; prepared policies for Medical Director review, and implemented policy into production

 

 

CHILDREN’S WELLNESS CENTER, Atlanta, GA                                                                                                                Oct. 2005- Jan. 2007

Pediatric Practice Administrator

  • Ensured smooth and effective operation of clinic at all times.
  • Credentialed physicians with insurance companies.
  • Managed contracts and negotiations
  • Coded all patient claims from office visits and hospital visits.
  • Selected and set up Electronic Billing network for practice
  • Choose appropriate Practice software and  EMR system and trained staff
  • Billing to all commercial insurances and Medicaid.
  • Wrote appeal letters to get claims paid
  • Resolved problems with patients and insurance companies
  • Performed and send claims via Electronic Billing
  • Validating Medicaid eligibility
  • Renewed and kept current professional licenses.
  • Responsible for research, development, marketing and project management.
  • Utilized accounting functions such as QuickBooks entries, insurance billing & collections; entered charges, posted payments & adjustments to accounts; managed payroll; performed month-end closing & balancing; printed aging & other monthly reports Hire, terminate & manage staff members; resolved personnel issues and responsible for new employee orientation.
  • Performed IT support for minor to medium problems.
  • Responsible for Medicaid referrals and HMO referrals
  • Maintained company calendars, call schedules and managed schedule for providers.
  • Interfaced with clients, vendors and partners.

 

GEORGIA PEDIATRIC PULMONOLOGY ASSOCIATES, Atlanta, GA                                                                                         Jul. 2003- Oct. 2005

Front Office Manager

  • Enforced adherence of employees to follow dress and conduct code.
  • Assisted in setting up new EMR (Electronic Medical Records)
  • Converted paper records into new EMR system
  • Managed Medical Records and Reception Department
  • Worked with drug representatives and provider relations representatives
  • Completed payroll on daily and weekly basis for all front desk personnel.
  • Organized and maintained front office records and equipment.
  • Controlled the inventory of front office supplies and forms.
  • Coded records and entered charges for all commercial and government insurances.
  • Assured all guidelines were met for Medicaid billing and referrals.
  • Balanced receipts and deposits.
  • Maintained communication channels within the front desk staff and related departments.
  • Set up new employees with access codes for computer.
  • Maintained schedules for 17 physicians and providers.
  • Performed employee evaluations and maintained annual PTO accruals.
  • Assured that all patient information was accurately entered into data base and files.
  • Responsible for timely patient flow.
  • Assured that the front office ran smoothly.

 

 

4DYNAMIC BILLING, Tampa, FL                                                                                                                                                         Dec. 1999- Jul. 2003

Billing/Coding Manager                                                                                                                                                                       (Contract Assignments)

TAMPA OUTPATIENT SURGERY CENTER, Tampa, FL

Billing Office Manager/Coding Supervisor

  • Oversaw and assisted with all electronic billing and paper claims.
  • Performed all claims adjudication functions for each medical practice.
  • Oversaw posting of payments to accounts.
  • Responsible for billing of ALL insurance (Medicaid, Medicare, government, BCBS, all Commercial)
  • Oversaw collections to assure that A/R remained current.
  • Generated monthly reports for each medical practice.
  • Attended seminars and training sessions for insurance and coding updates and trained staff on latest US insurance rules and updates.
  • Handled specialty medical areas of Anesthesiology, Ambulatory Surgical Centers, Podiatry, OB GYN/Infertility, Internal Medicine and Pulmonologists.
  • Performed EOB analysis and management.
  • Trained on Medic, Medical Manager, Medisoft and Advantx software programs.
  • Managed billing operation.
  • Managed accounts receivable and accounts payable including payroll.
  • Served as liaison between collection agencies, attorneys and surgical center.
  • Effectively managed business office personnel.
  • Negotiated new managed care contracts and maintained existing contracts.
  • Handled all JCAHO issues and preparations for the department.
  • Trained medical staff on coding, billing and reimbursement issues.

 

SOFTWARE SKILLS                                                                                                                                                                                                            

  • Proficient in MS Word,  Project Mgmt, Excel, Access,  Power-point, Oracle, Lotus Notes, Outlook, QuickBooks,  Medical Mgr, EMR/EHR, Web-Intellegence , Medicaid Management Information System, Clear Quest, Reqweb, Visio, Sharepoint
  • ID#: 73357
  • Location: Atlanta, GA , 30328

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