Kelley Hunter
Indianapolis
Summary
Experienced Analyst with a demonstrated history of working in the Human Services & Health Care industry. Skilled in Administration, Business Administration, Compliance Management and Consulting. Strong professional with a Master of Health Care Administration focused in Health Care Administration/Management.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Business Process Specialist
PUBLIC CONSULTING GROUP
01.2019 - Current
- A key player within the Human Services practice area and project manager for the Indiana Vocational Rehabilitation Claim Payment System and technical support for vocational rehabilitation vendors
- Leads analysis sessions with clients to determine project requirements for Sprint development work
- Support end-users to achieve timely adjudication of payment through the practice of creating and analyzing quality assurance reports
- Provide technical support and training to call center agents on the system
- Create and analyze reports for clients
- Collects data, performs root cause analysis of issues or problems, and proposes solutions according to the current and future needs of the business
- Accounts receivable management, troubleshooting issues with EFT bounce-back and supporting client invoicing with weekly invoices for claims to ensure funds are received.
Contract Compliance Manager
Medicaid-Indiana Family and Social Services administration
01.2017 - 01.2019
- Oversaw preparation and revision of contracts
- Maintain knowledge of assigned contract while enforcing compliance revisions
- Facilitate meetings and draft agendas to ensure compliance according to current contracts
- Assessment of document reports and ensure compliance with regulations submitted by Managed Care Entities contracted with Indiana State Medicaid
- Also, coordinating with Managed Care Entities to ensure the proper contract documents are received timely
- Contribute to policy monitoring and reviewing marketing material, evaluation of liability, analyze key metrics and complaints, researching health claims, and assist subrogation staff in recovery
- Ensure contract compliance through Managed Care Entity document reviews, establish and monitor corrective action plans.
Contract Compliance Analyst
Medicaid-Indiana Family and Social Services administration
01.2016 - 01.2017
- Analyzed monthly, quarterly, and annual reports sent from Managed Care Entities
- Receive, Research, and respond to the Office of the Governor and internet quorums from members and providers, verifying eligibility and coverage for Medicaid members
- Conducted medically frail audits, assess outcomes
- Review and revise reporting manuals and data reports, verify capitation rates.
Appeals Representative I
Anthem-National Government Services
01.2014 - 01.2016
- Adjust, analyze, investigate, approve or deny and process Medicare Part B claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement
- Ensured appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs
- Summarized and presented essential information for clinical specialists, medical directors and legal counsel
- Documented inquiry/appeal/grievance information on the second level of Grievance and Medicare Appeals Tracking systems for accurate tracking and analysis
- Research and determinations on complex second level of Medicare appeals from a variety of sources including state/federal regulators, members, media, and attorneys representing members
- Reviewed provider billing patterns, detected risks, and reviewed enrollment changes.
Education
Masters Degree - Health Care Administration
Purdue University Global Online
12.2016
Bachelors of Science - Health Science
Ball State University
12.2013
Skills
- SQL
- Salesforce
- Stakeholder Engagement
- Data entry
- Process Mapping
- Medical terminology
- Customer service
- Funds management
- Database maintenance
- Leadership
- Program planning
- Microsoft Office
Certification
Google Data Analytics Certificate
Timeline
Business Process Specialist
PUBLIC CONSULTING GROUP
01.2019 - Current
Contract Compliance Manager
Medicaid-Indiana Family and Social Services administration
01.2017 - 01.2019
Contract Compliance Analyst
Medicaid-Indiana Family and Social Services administration
01.2016 - 01.2017
Appeals Representative I
Anthem-National Government Services
01.2014 - 01.2016
Masters Degree - Health Care Administration
Purdue University Global Online
Bachelors of Science - Health Science
Ball State University
Similar Profiles
Sara OnsomuSara Onsomu
Healthcare Compliance Investigator Supervisor at Public Consulting GroupHealthcare Compliance Investigator Supervisor at Public Consulting Group
Chataun BarnettChataun Barnett
Client Services Associate at Public Consulting GroupClient Services Associate at Public Consulting Group
Breanna TracyBreanna Tracy
Investigator Supervisor/ Contact Tracer Supervisor at Public Consulting GroupInvestigator Supervisor/ Contact Tracer Supervisor at Public Consulting Group
Alexandra DardatiAlexandra Dardati
Health Recruiter at Public Consulting GroupHealth Recruiter at Public Consulting Group
Albert TorresAlbert Torres
Director of Clinical Operations at Emergency Dental of AmericaDirector of Clinical Operations at Emergency Dental of America