Business Analyst/Security Analyst
EVELIA LYNN MILLARD, CPC
7202 Lancaster Loop NE
Atlanta, GA 30328
(H) 770-481-0573 * (C) 678-641-6012
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)
- Certified Professional Coder (CPC), American Academy of Professional Coders (AAPC)
- Certificate in Medical Terminology
- Certified Nursing and Home Health Assistant
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.
- 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