LaShonda Anema

• Created project plans to fit stakeholder and customer needs and deliver with-in budget on desired outcomes, full accountability for project results
• Defined project roles and responsibilities in close collaboration with Customer, including project scope and objectives to ensure cross-functional understanding amongst project members
• Performed project tracking through clear and concise status reports and time management reports: proactively identify potential issues and track project member progress against commitments
• Identified from recent projects to identify and recommend improvements, cost saving initiatives and substitutions to positively impact current and future project budget and schedule
• Coordinated claim, reporting, and audit projects within expected scope of business
• Interact with providers to resolve clinical issues, documentation, and billing errors.
• Developed reports and deliverables for management and communicated with all levels of stakeholders.
• Identified new audit areas by screening and analysis audit projects
• Developed white papers to overview of new audit opportunities
• Documented and validate billing discrepancies to providers and SLT
• Evaluated complex data sets
• Independently problem-solved and research data anomalies
• Trained and guides other associates on data segmentation, payment integrity functional updates, and audits
• Evaluate complex algorithms, review data sets, independently problem-solve and research data anomalies
• Maintain day to day operation of over 42 accounts including Data mining, COB, Aetna RM/ AV, 340B Projects, Data Collections & Pharmacy audit.
• Coordinates and manages client related internal meetings such as scheduling, facilitation, meeting agenda/material preparation, meeting minutes/action item tracking. (Humana)
• Develop and maintain organizational Key performance Indicator to identify trends.
• Developed and provides on-going business intelligence reporting to external and internal clients.
• Developed set of reports needed to support decision-making that drives operational excellence, superior customer services, increased revenue and profitability by 45%.
• Analyzes monthly results and draft monthly performance summary for client, providing insight and observations on drivers of trends and status of initiatives.
• Responsible for recommending, developing and implementing policies and processes in support of collecting funds for client and maintaining strong provider relations.
• Manages Audit Support work to achieve goals; and monitors and ensures all activities performed are consistent with established company and audit guidelines.
• Collaborate and assign goals to global workforce team
• Understand contract language and ability to negotiate
• Built client relationships by responding to inquiries, identifying and assessing clients' needs, resolving problems, and following up with potential and existing clients.
• Managed projects from procurement to commission.
• Established performance and service goals and held associates accountable for individual performance.
• Performed duties and provided service in accordance with established operating procedures and company policies.
• Handled complaints, provided appropriate solutions and alternatives within appropriate timeframes and followed up to achieve resolution.
• Developed and initiated projects, managed costs, and monitored performance.
• Achieved project deadlines by coordinating with contractors to manage performance.
• Identified plans and resources required to meet project goals and objectives.
• Planned, designed, and scheduled phases for large projects.
• Maintained client files with sales contracts, records of client interactions, client notes, and other information.
• Met project deadlines without sacrificing build quality or workplace safety.
• Partnered with business leaders to deliver services that support company objectives and consistent with corporate values.
• Interacted with clients on regular basis to quickly alleviate issues and provide project updates.
• Negotiated and managed third-party contracts related to project deliverables.
• Encouraged creative thinking, problem solving and empowerment as part of facility management group to improve morale and teamwork.
• Monitored project performance to identify areas of improvement and make adjustments.
• Scheduled and attended meetings with clients and prospective clients as requested.
• Developed new employees and on-going performance assessment of current employees.
• Kept stakeholders up-to-date on details pertaining to client projects.
• Collaborated with finance department on invoicing accuracy for applicable products, services, software and logistics.
• Drafted project reports to identify successful outcomes, insights and future recommendations.
• Delivered outstanding service to clients to maintain and extend relationships for future business opportunities.
• Delegated tasks to existing support team members and used cloud-based tools to help solve complex business issues.
• Coordinated material procurement and required services for projects within budget requirements.
• Provided detailed project status updates to stakeholders and executive management.
• Mentored departmental team, boosting efficiency, success and morale among employees.
• Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitation of proactive work environment.
• Provided detailed technical and operational direction in project challenges, consistently meeting deliverables according to deadlines.
• Developed and implemented strategic project plans to meet business objectives.
• Coordinated with cross-functional teams to resolve project issues and mitigate risks.
• Prepared and submitted project invoices for review and approval.
• Implemented process improvement to shape organizational culture, optimize procedures for higher efficiency and help company evolve and grow.
• Identified and resolved unauthorized, unsafe, or ineffective practices.
• Set, enforced, and optimized internal policies to maintain responsiveness to demands.

• Maintains combined set of reports to provide audit leaders with information needed to support decision-making that drives operational excellence, superior customer services, increased revenue and profitability.
• Plans, schedules and coordinates work of department to achieve stated goals.
• Implements and utilizes metrics to monitor and ensure all activities are performed consistently within established company and audit guidelines.
• Maintains efficient workflow by holding direct reports accountable for quality and efficiency of their work.
• Provides guidance and effectively coaches employees to achieve desired results and overall performance, encouraging discussions for realistic achievement plans for long-term growth.
• Maintains consistency in applying company and departmental policy decisions by accurately and timely documenting employee files, including attendance, performance information, documented warnings, time off requests, coaching information, training information, etc.
• Built application platform foundation to support migration from client-server product lines to enterprise architectures and services.
• Monitored network performance and provided network performance statistical reports for both real-time and historical measurements.
• Developed work-flow charts and diagrams to ensure production team compliance with client deadlines.
• Cultivated productive and safe atmosphere while supervising team of 35 employees.
• Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
• Coached team members in techniques necessary to complete job tasks.
• Managed schedules, accepted time off requests and found coverage for short shifts.
• Trained new team members by relaying information on company procedures and safety requirements.
• Worked different stations to provide optimal coverage and meet production goals.
• Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
• Adjusted equipment to meet different productivity levels.
• Directed and supervised team of 35 engaged in 1:1 and career development.
• Designed strategic plan for component development practices to support future projects.
• Developed monthly and daily production output plans to deliver on customer service and financial metrics.
• Audited team performance and compliance with Operations auditing scope standards.
• Mentored and guided employees to foster proper completion of assigned duties.

• Supervise and motivate staff.
• Monitor operating costs, budgets and resources.
• Communicate with clients and evaluate their needs and specifications.
• Create reports, analyze and interpret data.
• Drive recruitment process and training & development.
• Secure adherence to company's policies and guidelines.
• Coach and training current and new employees.
• Solve problems by identifying errors and overpayments for our healthcare clients.
• Use your creativity to help generate new ideas for claim concepts and recovery opportunities.
• Learn and use multiple computer software, systems and technology.
• Achieve excellence by meeting and exceeding audit team goals and quality measures.
• Serve clients by responding to questions or inquiries.
• Processed Corrected claims, disputes and appeals.
• Process and maintain prepayment and post payment invoices.
• Perform variety of support and general administrative assignments in support of audit or auditors, including filing, data entry, and tracking/correspondence while following established standards and work processes.
• Examined and indexed medical records to be audited by Complex Chart Validation team.
• Assist manager in organizing, planning and implementing strategy.
• Coordinate operations.
• Ensure schedules and objectives are met in timer manner.
• Answered customer phone calls to address questions and provide assistance with prescriptions.
• Organized client information into correct profiles while maintaining confidentiality.
• Tracked pharmacy inventory and reported medication numbers to lead pharmacists.
• Requested updated prescriptions and medical information from physicians.

Handles administrative tasks in an efficient and accurate manner.

• Efficiently and professionally handles the daily administrative activities within the department, to assist auditor(s), collectors, managers, Business Optimization and others to meet and exceed customer expectations.
• Perform a variety of support and general administrative assignments in support of the audit or auditors, including filing, data entry, and tracking/correspondence while following established standards and work processes.
• Serves as a point of contact and facilitates responses to general inquiries and data requests from both internal and external customers.
• As requested, or required, communicates directly with the client or providers following established processes and procedures.
• This role is responsible for examining and indexing medical records to be audited by the Complex Chart Validation team.
• Develops and provides on-going business intelligence reporting.
• Produced ad hoc reports and documents for senior team members.
• Developed a new process for employee evaluation which resulted in marked performance improvements.
• Kept clients engaged in social networks and communities for personal health and growth.
• Prepared agendas and took notes at meetings to archive proceedings.
• Created, prepared, and delivered reports to various departments.
• Monitored employee and customer interactions to assess quality of service.
• Prepared employee schedules for maximum coverage during key hours.
• Coached employees through day-to-day work and complex problems.
• Assessed personnel performance and implemented incentives and team-building events to boost morale.
• Developed and implemented procedures for responding to customer inquiries and resolving technical issues.
• Analyzed customer service data to identify trends, identify solutions and improve customer experience.
• Developed and maintained relationships with customers to enhance customer satisfaction.
• Set priorities and problem-solved workflow issues to maintain rapport with customers and managers.
• Managed specialist team to provide technical assistance and customer service.
• Monitored customer service metrics and provided feedback to team members, upholding quality standards.
• Created and implemented maintenance plans for customer accounts to secure customer satisfaction and reliability.
• Collaborated with other teams to identify and resolve customer issues quickly and professionally.

• Prepared and updated job description records for all employees across company.
• Collaborated with recruiters to help develop compensation packages and maintain fair employee pay levels.
• Updated personnel handbooks and individual records to keep filed accurate and detailed.
• Delivered targeted advise on issues such as applicable employment regulations, compensation strategies, and internal systems to help companies update antiquated or ineffective approaches.
• Proactively obtain case related details and documents either directly from Providers or from within a Provider's database.
• Properly transfer all case related data to MedRisk's database, organize related documents efficiently and provide well-written documentation to ensure consistent communication across departments.
• Proactively communicate with referring adjusters and nurse case managers through succinct, professionally written email communications.
• Research individual adjuster or nurse case manager issues within MedRisk and provide findings and resolution to the customer and appropriate Regional Sales Manager.
• Research client specific workflows and become familiar with the client's unique needs and respond appropriately.
• Build an approachable, professional relationship with both Providers and referring customers.
• Maintained strong working knowledge of Department of Labor's Fair Labor Standards Act and other regulations.
• Recommended successful approaches to help resolve complaints with salaries and classifications.

• Confirmed consultative reports and diagnostic test results.
• Determined appropriate examinations, tests and specialists required for each case.
• Scheduled follow-up and rescheduled appointments for examinees.
• Updated documents such as municipal codes and city charters.
• Reviewed patient's medical chart to verify DRG
• Serve as a liaison between the hospital and departments
• Document hospital communication into database
• Identify claims that are insufficient for claim processing as incomplete
• Identify the difference between government/commercial payers for appeals (Medicare, Medicaid and Managed care)
• Identify overpayment amount for client reimbursement
• Research claim reimbursement amounts per client's request

• Coordinated multiple facets of process without sacrificing performance.
• Administered patient follow-up, data collection, clinical monitoring and coordination with primary health care providers.
• Documented each patients' activity in program-specific databases.
• Maintained current knowledge of applicable procedures and compliance requirements to optimize effectiveness.
• Importing patient's data electronically into the Executive Health Resources clinical database.
• Accessing client clinical systems to obtain data to enter into the Executive Health Resources clinical database.
• Ensuring accuracy and completeness of information entered into the Executive Health Resources clinical database.
• Assisting with identification and correction of inaccurate and incomplete information.
• Establishing and maintaining permanent electronic files.
• Performing other related duties as required.
• Answer telephones promptly and courteously between Registered Nurses and Physicians
• Entering patient's demographics and clinical data into the Executive Health Resources clinical database.

• Completed proper sanitation and cleaning of equipment and work areas between patients.
• Tracked collected specimens by initialing, dating, and noting times of collection.
• Stocked phlebotomy cart or carrier with appropriate supplies.
• Monitored patients for reactions and verified sample quality.
• Entered blood donors' information into the American Red Cross's database.
• Set-up blood drives per request of different organizations, prospective blood donors, and provided information to implement blood drives to prospective organizations and blood donors.
• Mail out appointment cards and directions from the American Red Cross to prospective blood donors.