Lynne Ward
Little Rock, Arkansas 72211
501-951-1323 (cell)
Contact Information
lynnewardworkshard@gmail.com
Blog and profile Site:
http://www.thebossatblog.blog.com/
Current Status of Employment
While unemployed, I have advanced my education. During the interim while attending classes full time, I have written policies and procedures for medical clinics as well as perform office manager duties including develop compliance programs with metric systems. I have been performing volunteer work with my children’s school as well as serve as a previous employers’ Meal on Wheels designee for Little Rock. My desire is to work full time and develop a long-term relationship with the company I am employed.
Please consider my resume’ for any position for which you believe I may be qualified.
Professional Experience
United HealthCare of Arkansas June 2005 – June 2006
(Left in June 06 for Graduate School - MBA) Network Account Manager
415 N. McKinley
Little Rock, AR 72205
Reference: Larry Nall, Vice President Southeast Region, Nashville, Tennessee
Primary responsibilities include:
· Handling assigned physician network development for Arkansas’s largest physician base, “Central Arkansas” as well as South Arkansas Emergency Room Contracting, fee reimbursement schedules, accounts receivable assistance with the physician clinics and coordinating special medical circumstances for patients and physician’s.
· Worked with the Corporate office to collect HEDIS clinical information from many clinics throughout the state
· Bi-weekly reporting to Corporate office regarding progress on assigned projects
· Accreditation involvement and reporting of progress to Corporate office
· Claim Project coordination acting as a provider advocate between the Company and participating providers (performing detailed claim audit and review, assisting clients with their A/R issues and performing a wide range of claim projects checking for payment against contract rates and UHC adjudication outcomes along with spread-sheeting entire projects)
· Provider issue mediation and resolution
· Developing new contracts and renewing existing contracts
· Negotiating contracts from beginning to end
· Developing and maintaining business/client relationships
Lynne Ward, Resume, Page 2
Arkansas Specialty Care Centers, P.A. (2001-2005) Concluded June 2005
600 S. McKinley, Ste. 405 Quality and Compliance/Contracts
Little Rock, AR. 72205
Reference: Alicia Cooper, Former CEO and Supervisor 501-951-2656
My reference for the complete length of my employment with Arkansas Specialty Care Centers was Alicia Cooper, 951-2656.
Accomplishments
· Responsible for Company wide coordination and compliance to State, Federal and Accrediting Body standards of patient care and service/finance, HIPAA, RFP's, and all other metrics and operational processes regarding claim management, medical records, patient satisfaction, measurements, records retention/storage & destruction, all patient complaints, disclosures, confidential/privacy telephone lines for patients and employees to report any type of OSHA/HIPAA and Company standard violation and investigation of all reports made on these privacy lines….
· Communicated on a weekly basis regarding active (open) legal physician/patient issues as well as with third parties when required
· Maintained litigation files for each of the twenty-three physician's as well as communicated and participated in most legal affairs of the Company
· Research and development of Corporate and Clinic Compliance/Quality Improvement Program, plan and annual analysis
· Developed specific ancillary and clinic monitors with benchmarks as well as HIPPA and OSHA Audit tools and audit calendars for each clinic location
· Updated Charge Master Annually
· Analyzed payor fee schedules annually, or as often as needed
· Renewed payor vendor contracts as needed
· Performed RVU, Charges and Collections Audit monthly
· Acted as liaison between the Corporate Office and clinic locations for review and approval of payor requested refunds, credit balance accounts and the surgery center business office
· Implemented the developed process for collections the ASCC selected collections vendor
· Monitored weekly and monthly Collection Agency reports, payments and accounts being sent to the agency for validation and compliance
· Maintained and assisted private attorneys with coordination of most physician depositions and patient incidents
· Reviewed compliance metrics in all clinic locations on a monthly basis
· Performed annual E&M Coding audit for all physicians to realize and analyze the billing and coding patterns of office visits (special focus on the Inspector General’s compliance plan items), surgeries and timeliness of dictation and transcription in all locations for each physician
Lynne Ward Resume, Page 3
Arkansas Specialty Care Centers, P.A. April 2001-June 2001
600 S. McKinley, Ste. 405 Temporary Consulting Position
Little Rock, AR. 72205 Hired Full Time June 2001
Reference: Alicia Cooper, Former CEO and Supervisor, 501-951-2656
Accomplishments
· Research and development of Corporate and Clinic Compliance/Quality Improvement Program
· Developed specific ancillary and clinic monitors with benchmarks as well as HIPPA and OIG Compliance forms and patient check-in procedures
· Took minutes in Board of Directors meetings as well as Shareholder meetings,
· Assisted the Coding and Auditing Supervisor in development of E&M coding training for the physicians and staff
· Performed Annual E&M Analysis for January 2000-2001 (new patient visit codes, established patient visits and consultation codes). Produced a report card for 22 physicians as well as an overall Company utilization table with graphics depicting over
and under utilization and high risk areas and physicians
· Assisted the MRI Center with the United Health Group JCAHO preparation site audit
· Prepared the MRI Center to obtain American College of Radiology (ACR) Accreditation
· Assisted a newly hired APN in the development of the Arkansas Specialty Back Care Program start-up and operations policies and forms
· Assisted Company Managers with clinic policies as needed.
QualChoice/QCA of Arkansas February 2001-April 2001
10800 Financial Centre Parkway, Suite 540 “Temporary Manager” Provider Relations
Little Rock, AR. 72211
QCA “3 Month Temporary Placement after having baby”
Duties and Responsibilities
1 Organized Credentialing staff
2 Organize training on claim system and credentialing system for all Provider Relations Staff,
3 Assisted large clients with year-end Accounts Receivable close out (ACH & UAMS)
4 Review and Development of provider network to include facilities, allied providers, primary care providers and specialty care providers,
3 Month Temporary Position Accomplishments
· Developed Provider Relations and Credentialing Procedures Manual,
· Achieved all duties listed above
· Organized the process for address changes, provider terms and additions,
· Developed standard analysis report format in excel for claims review and analysis to service customers requesting claims review for 6 months back and then annual,
· Put quality assurance monitors in place to track provider load errors, data entry errors and to detect inconsistencies between a provider or facilities Federal Identification Number and payment mapping,
· Cleaned 5 years of inconsistent 1099 data in the claims payment system,
· Assisted in the purchase of network directory software (GeoAccess), and
· Developed Company policies for Inpatient Consultation Payment and OB Anesthesia Payment Procedures.
Lynne Ward Resume, Page 4
NovaSys Health Network March 1997 – September 2000
Director of Care Management/Quality Improvement (Stayed at home with new baby
Utilization Management & Provider Relations/Credentialing in September 2000)
Little Rock, AR 72211
Reference: Steve Shelton, VP Operations, 501-219-4444
Duties and Responsibilities
· Direct supervision and oversight of Credentialing, Provider Relations, Quality Improvement and Utilization Review staff
· Selection, hiring, training, development and performance appraisals of Credentialing, Provider Relations and Utilization Management staff
· Quality Improvement/Committee and Company Governance development and implementation
· Development of Company Quality Improvement documents to include, Written Quality Improvement Program, Program Description and Summary, Annual Review/Evaluation Format and development of monitors for all departments
· Responsible for all company compliance and Utilization Review Certification in 42 states
Selected to service on country wide Quality Improvement committee for Quorum Health Resource networks
· Assisted PHO Directors in the state to advance their physician application procedures
· Assisted PHO Directors in the state regarding their understanding of health care, managed care and credentialing/utilization review services, third party administrator services...
· Developed Credentialing Delegation policies and procedures along with the applicable forms
The Prudential Insurance Company of America March 1995 – March 1997
Prudential HealthCare of Arkansas
Quality Improvement Coordinator, 1995
Reference: Alicia Cooper, Former Supervisor, 501-951-2656
Duties and Responsibilities
· Received training from direct superior in applicant interviewing, hiring and developing performance appraisals
· Strategic planning with Management Team to achieve departmental and overall health plan goals/objectives
· Assisted in coordinating and training all departments in the health plan and all activities within Prudential HealthCare – Arkansas for preparation of renewing the second NCQA Accreditation. Outcome, Full Accreditation with sited deficiencies that were corrected
· Organization of activities needed for the Health Care Finance and Administration (HCFA) – Federal Qualification site visit review, outcome successful
· Organized health plan to receive the State Utilization Review Certification, outcome successful.
· Completed the HEDIS audit for the state of Arkansas, first in the Country. Health Plan was invited to assist other Prudential health plans within the country to organize and complete their HEDIS audits. Wrote the Arkansas verbiage for the statistical studies and submitted to the Corporate office
Lynne Ward Resume, Final Page 5-5
· Responsible for RFP coordination through out all departments in the health plan. Worked closely with the Marketing Director on all RFP's, the deadlines and the final review of information therein.
Personal and Professional References Are Immediately Available
Alicia Cooper, Previous CEO and Supervisor of Arkansas Specialty 501-951-2656 (cell)
Steve Shelton VP Operations, NovaSys Health Network 501-219-4446 (office),
501-960-7887 (cell)
Kila Hau, United HealthGroup, Little Rock (Previous Arkansas CEO) 501-217-0517 (home, retired)
Marsha Ballard, General Counsel, University of Arkansas for Medical Sciences (UAMS),
501-993-5483 (cell), 501-526-5029 (office)
Education
Louisiana State University (Completed) December 1984 – December 1989
Contact Information
lynnewardworkshard@gmail.com
Blog and profile Site:
http://www.thebossatblog.blog.com/
Current Status of Employment
While unemployed, I have advanced my education. During the interim while attending classes full time, I have written policies and procedures for medical clinics as well as perform office manager duties including develop compliance programs with metric systems. I have been performing volunteer work with my children’s school as well as serve as a previous employers’ Meal on Wheels designee for Little Rock. My desire is to work full time and develop a long-term relationship with the company I am employed.
Please consider my resume’ for any position for which you believe I may be qualified.
Professional Experience
United HealthCare of Arkansas June 2005 – June 2006
(Left in June 06 for Graduate School - MBA) Network Account Manager
415 N. McKinley
Little Rock, AR 72205
Reference: Larry Nall, Vice President Southeast Region, Nashville, Tennessee
Primary responsibilities include:
· Handling assigned physician network development for Arkansas’s largest physician base, “Central Arkansas” as well as South Arkansas Emergency Room Contracting, fee reimbursement schedules, accounts receivable assistance with the physician clinics and coordinating special medical circumstances for patients and physician’s.
· Worked with the Corporate office to collect HEDIS clinical information from many clinics throughout the state
· Bi-weekly reporting to Corporate office regarding progress on assigned projects
· Accreditation involvement and reporting of progress to Corporate office
· Claim Project coordination acting as a provider advocate between the Company and participating providers (performing detailed claim audit and review, assisting clients with their A/R issues and performing a wide range of claim projects checking for payment against contract rates and UHC adjudication outcomes along with spread-sheeting entire projects)
· Provider issue mediation and resolution
· Developing new contracts and renewing existing contracts
· Negotiating contracts from beginning to end
· Developing and maintaining business/client relationships
Lynne Ward, Resume, Page 2
Arkansas Specialty Care Centers, P.A. (2001-2005) Concluded June 2005
600 S. McKinley, Ste. 405 Quality and Compliance/Contracts
Little Rock, AR. 72205
Reference: Alicia Cooper, Former CEO and Supervisor 501-951-2656
My reference for the complete length of my employment with Arkansas Specialty Care Centers was Alicia Cooper, 951-2656.
Accomplishments
· Responsible for Company wide coordination and compliance to State, Federal and Accrediting Body standards of patient care and service/finance, HIPAA, RFP's, and all other metrics and operational processes regarding claim management, medical records, patient satisfaction, measurements, records retention/storage & destruction, all patient complaints, disclosures, confidential/privacy telephone lines for patients and employees to report any type of OSHA/HIPAA and Company standard violation and investigation of all reports made on these privacy lines….
· Communicated on a weekly basis regarding active (open) legal physician/patient issues as well as with third parties when required
· Maintained litigation files for each of the twenty-three physician's as well as communicated and participated in most legal affairs of the Company
· Research and development of Corporate and Clinic Compliance/Quality Improvement Program, plan and annual analysis
· Developed specific ancillary and clinic monitors with benchmarks as well as HIPPA and OSHA Audit tools and audit calendars for each clinic location
· Updated Charge Master Annually
· Analyzed payor fee schedules annually, or as often as needed
· Renewed payor vendor contracts as needed
· Performed RVU, Charges and Collections Audit monthly
· Acted as liaison between the Corporate Office and clinic locations for review and approval of payor requested refunds, credit balance accounts and the surgery center business office
· Implemented the developed process for collections the ASCC selected collections vendor
· Monitored weekly and monthly Collection Agency reports, payments and accounts being sent to the agency for validation and compliance
· Maintained and assisted private attorneys with coordination of most physician depositions and patient incidents
· Reviewed compliance metrics in all clinic locations on a monthly basis
· Performed annual E&M Coding audit for all physicians to realize and analyze the billing and coding patterns of office visits (special focus on the Inspector General’s compliance plan items), surgeries and timeliness of dictation and transcription in all locations for each physician
Lynne Ward Resume, Page 3
Arkansas Specialty Care Centers, P.A. April 2001-June 2001
600 S. McKinley, Ste. 405 Temporary Consulting Position
Little Rock, AR. 72205 Hired Full Time June 2001
Reference: Alicia Cooper, Former CEO and Supervisor, 501-951-2656
Accomplishments
· Research and development of Corporate and Clinic Compliance/Quality Improvement Program
· Developed specific ancillary and clinic monitors with benchmarks as well as HIPPA and OIG Compliance forms and patient check-in procedures
· Took minutes in Board of Directors meetings as well as Shareholder meetings,
· Assisted the Coding and Auditing Supervisor in development of E&M coding training for the physicians and staff
· Performed Annual E&M Analysis for January 2000-2001 (new patient visit codes, established patient visits and consultation codes). Produced a report card for 22 physicians as well as an overall Company utilization table with graphics depicting over
and under utilization and high risk areas and physicians
· Assisted the MRI Center with the United Health Group JCAHO preparation site audit
· Prepared the MRI Center to obtain American College of Radiology (ACR) Accreditation
· Assisted a newly hired APN in the development of the Arkansas Specialty Back Care Program start-up and operations policies and forms
· Assisted Company Managers with clinic policies as needed.
QualChoice/QCA of Arkansas February 2001-April 2001
10800 Financial Centre Parkway, Suite 540 “Temporary Manager” Provider Relations
Little Rock, AR. 72211
QCA “3 Month Temporary Placement after having baby”
Duties and Responsibilities
1 Organized Credentialing staff
2 Organize training on claim system and credentialing system for all Provider Relations Staff,
3 Assisted large clients with year-end Accounts Receivable close out (ACH & UAMS)
4 Review and Development of provider network to include facilities, allied providers, primary care providers and specialty care providers,
3 Month Temporary Position Accomplishments
· Developed Provider Relations and Credentialing Procedures Manual,
· Achieved all duties listed above
· Organized the process for address changes, provider terms and additions,
· Developed standard analysis report format in excel for claims review and analysis to service customers requesting claims review for 6 months back and then annual,
· Put quality assurance monitors in place to track provider load errors, data entry errors and to detect inconsistencies between a provider or facilities Federal Identification Number and payment mapping,
· Cleaned 5 years of inconsistent 1099 data in the claims payment system,
· Assisted in the purchase of network directory software (GeoAccess), and
· Developed Company policies for Inpatient Consultation Payment and OB Anesthesia Payment Procedures.
Lynne Ward Resume, Page 4
NovaSys Health Network March 1997 – September 2000
Director of Care Management/Quality Improvement (Stayed at home with new baby
Utilization Management & Provider Relations/Credentialing in September 2000)
Little Rock, AR 72211
Reference: Steve Shelton, VP Operations, 501-219-4444
Duties and Responsibilities
· Direct supervision and oversight of Credentialing, Provider Relations, Quality Improvement and Utilization Review staff
· Selection, hiring, training, development and performance appraisals of Credentialing, Provider Relations and Utilization Management staff
· Quality Improvement/Committee and Company Governance development and implementation
· Development of Company Quality Improvement documents to include, Written Quality Improvement Program, Program Description and Summary, Annual Review/Evaluation Format and development of monitors for all departments
· Responsible for all company compliance and Utilization Review Certification in 42 states
Selected to service on country wide Quality Improvement committee for Quorum Health Resource networks
· Assisted PHO Directors in the state to advance their physician application procedures
· Assisted PHO Directors in the state regarding their understanding of health care, managed care and credentialing/utilization review services, third party administrator services...
· Developed Credentialing Delegation policies and procedures along with the applicable forms
The Prudential Insurance Company of America March 1995 – March 1997
Prudential HealthCare of Arkansas
Quality Improvement Coordinator, 1995
Reference: Alicia Cooper, Former Supervisor, 501-951-2656
Duties and Responsibilities
· Received training from direct superior in applicant interviewing, hiring and developing performance appraisals
· Strategic planning with Management Team to achieve departmental and overall health plan goals/objectives
· Assisted in coordinating and training all departments in the health plan and all activities within Prudential HealthCare – Arkansas for preparation of renewing the second NCQA Accreditation. Outcome, Full Accreditation with sited deficiencies that were corrected
· Organization of activities needed for the Health Care Finance and Administration (HCFA) – Federal Qualification site visit review, outcome successful
· Organized health plan to receive the State Utilization Review Certification, outcome successful.
· Completed the HEDIS audit for the state of Arkansas, first in the Country. Health Plan was invited to assist other Prudential health plans within the country to organize and complete their HEDIS audits. Wrote the Arkansas verbiage for the statistical studies and submitted to the Corporate office
Lynne Ward Resume, Final Page 5-5
· Responsible for RFP coordination through out all departments in the health plan. Worked closely with the Marketing Director on all RFP's, the deadlines and the final review of information therein.
Personal and Professional References Are Immediately Available
Alicia Cooper, Previous CEO and Supervisor of Arkansas Specialty 501-951-2656 (cell)
Steve Shelton VP Operations, NovaSys Health Network 501-219-4446 (office),
501-960-7887 (cell)
Kila Hau, United HealthGroup, Little Rock (Previous Arkansas CEO) 501-217-0517 (home, retired)
Marsha Ballard, General Counsel, University of Arkansas for Medical Sciences (UAMS),
501-993-5483 (cell), 501-526-5029 (office)
Education
Louisiana State University (Completed) December 1984 – December 1989
Bachelors Degree of Science – Psychology
Certification
ABQAURP Certification (Completed and Granted) January 1997, current
(American Board of Quality Assurance and Utilization Review Physicians)
Recognized as the board for accrediting and compliance standards proficiency (Federal, State and other Accrediting Agencies)
Proficient in most Microsoft Products, advanced excel skills, power point and other software products including various claim processing software packages
My hobbies include running, cycling, tennis, continually educating myself, going to the beach each summer, spending time visiting with my parents, sisters and their children, reading and volunteering at the school my children attend in Little Rock, Arkansas.
Certification
ABQAURP Certification (Completed and Granted) January 1997, current
(American Board of Quality Assurance and Utilization Review Physicians)
Recognized as the board for accrediting and compliance standards proficiency (Federal, State and other Accrediting Agencies)
Proficient in most Microsoft Products, advanced excel skills, power point and other software products including various claim processing software packages
My hobbies include running, cycling, tennis, continually educating myself, going to the beach each summer, spending time visiting with my parents, sisters and their children, reading and volunteering at the school my children attend in Little Rock, Arkansas.
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