ABEL- "Always able to help you".

Education / Work Experience

• Apr 2025 - current
  Saber Healthcare Group /Wecare centers, Business Office Manager

  • Operational Transformation: Led digital transformation initiatives that increased operational efficiency by 30% and reduced manual billing errors by 25% through AI-enabled tools.

  • Revenue Enhancement: Orchestrated EHR and RCM system upgrades, resulting in significantly reduced AR days and enhanced reimbursement accuracy.

  • Contract Negotiation: Successfully negotiated payer contracts, securing a 7% increase in reimbursement rates.

  • Compliance & Audit: Conducted rigorous internal audits to ensure 100% HIPAA compliance and minimize denial rates across Medicaid and pharmacy billing..

• Dec 2023 - Apr 2025
  Management Internships –BNY Mellon & Carering Health LLC, Management Internships –BNY Mellon & Carering Health LLC

  Healthcare Management Internship – Carering Health LLC

  Dec 2024 – Apr 2025

  *Completed a healthcare management internship focused on home health operations and workforce administration.

  Managed payroll processing for 100+ home health employees, ensuring accuracy and regulatory compliance.

  Supported onboarding, disciplinary documentation, and workforce performance tracking to maintain operational efficiency.

  *Strengthened operational processes to improve staff accountability and service delivery.

  Resolved employee issues and assisted with internal audits involving vendors such as UPMC CHC and PA Health & Wellness CHC programs.

  *Handled incident reporting using HHAeXchange, the leading homecare software solution that connects providers, state Medicaid programs, and managed care organizations.

  *Supported additional revenue growth by increasing staff-to-client ratio from 150 to 165 over four months, resulting in $400,000 annual revenue increase on top of an existing $4M branch operation.

  BNY MELLON -12/2023 -4/2024

  *pension fund client portfolios by ensuring accuracy in reporting, strict compliance, and seamless service delivery.

  *Collaborated with senior leadership to optimize client communication workflows and improve overall service quality.

  *Contributed to a $7M revenue growth initiative through strategic relationship management and account expansion efforts.

  
  

  Software/Skills

  • Microsoft Copilot

  • Microsoft Dynamics CRM

  • HHA-hhaexchange-Electronic Visit Verification, Payroll, Compliance -billing with Medicaid -Contracted Insurance firms.

  • Google Meet -Google Office suite-GooGle Drive Sheets, Docs.

  • Microsoft Teams, Outlook, Excel, PowerPoint, MS Project.

  • Sales Force CRM- Health cloud

  • Leading international offshore cross-functional teams - India

  
  

  ---

  
  

  ---

  
  

  ---

  
  

  
  

• Jul 2019 - Oct 2023
  Highmark Inc., Operations Manager

  I managed three teams 37 employees split into four departments.

  • Exceeded government Service Level Agreements by 50% and increased KPIs by 25% through targeted project‑efficiency initiatives and disciplined call‑center operations management.

  • Leading a multi‑phase operational improvement strategy that included redesigning call‑flow processes, tightening workforce management practices, and deploying targeted efficiency projects across high‑volume queues. Strengthened training programs through revamped onboarding, competency‑based coaching, and real‑time QA feedback loops, while optimizing daily workflows with standardized procedures, performance dashboards, and cross‑functional escalation pathways.

  • Process Optimization: Cut grievance resolution time by 50% and boosted quality scores by 125% by implementing a compassionate, data-driven customer service framework.

  • Retention & Training: Redesigned workforce capability-building programs, leading to a 50% increase in employee retention and a 10% boost in overall team productivity.

  
  

  • Led efforts that doubled revenue recovery while surpassing 98% in quality scores, and I implemented technology-driven efficiencies that yielded over $2 million in administrative savings.
    
    
    

  
  

  Skills/Software

  • Business Analysis ·

  • Team Management ·

  • Team Leadership ·

  • Account Management ·

  • Microsoft Office ·-Outlook ,Excel, PowerPoint,

  • Workday Payroll /Beeline systems

  • FMLA- Claims Management

  • Workman's Compensation

  • • Project Management ·

  • Third-Party Vendor Management ·- Relationship Management.

  • Sales Force - CRM - Health Cloud

  • Cactus/ for Provider credentialing

  • Jira -project management software

  • Recruiting · interviewing , onboarding,

  • Process Improvement ·

  • Workforce Management - Analysis

  • Federal & State - Medicare and Medicaid compliance auditing .

  • MEDHOK - Provider Grievance -appeal software

  • Promise - system - Verification of benefits for Medicaid

  • CMS - novitas solutions

  • CVS-rx billing -overrides to resolve complex claim issues and served as the primary pharmacy contact for leadership‑level escalations, coordinating corrective action and ensuring timely resolution of high‑impact cases.

  
  

  
  

  
  

  
  

  
  

• Dec 2015 - Jul 2019
  UPMC, Transplant Credit Analyst & Provider Advocate

  Transplant Credit Analyst

  • Managed service level agreement (SLA) contracts for Children’s Hospital transplant services.

  • Trained across all organ transplant programs and met with families to explain benefits for complex cases, including cancer patients and kidney transplant recipients.

  • Utilized Epic extensively for patient records, billing, and benefit verification.

  
  

  Specialty Pharmacy Team – Patient Advocate
  
  

  • Served as a liaison between patients and pharmaceutical companies to secure medication access and financial assistance.

  • Completed and tracked PACE program applications, ensuring accurate demographic, income, and prescription data to meet Pennsylvania Department of Aging requirements.

  • Utilized Rx billing platforms to manage claim lifecycle, troubleshoot adjudication errors, and maintain compliance with Medicare, Medicaid, and commercial payer rules.

  • Grant application for Oncology and rare disease financial assistance with third party non-profit organizations.

  
  

  Provider Advocate
  
  
  

  • Acted as a liaison for providers across all UPMC health plans, resolving issues related to billing, authorizations, federal employee plans, Medicare, Medicaid, and ancillary services.

  • 
    Delivered end-to-end support for providers, ensuring compliance and timely resolution of claims and authorization challenges.

  • Took 60-75 calls per day along provider chat inquiries , UPMC Portal requests .

  • Mentor to new staff , and offered assistance on special projects.

  • Contributed to the Process Improvement Committee by designing a cross‑functional SharePoint‑sharing strategy that broke down departmental silos, improved transparency, and eliminated redundant communication tasks. The initiative required no additional budget and resolved a $110,000 cost barrier associated with overtime and duplicated communication efforts

  • 
    

  Skills /Software

  • UPMC Provider Portal -Insurance verification, Benefit review, Claim resolution,

  • Provider Manual Review - Compliance with multiple specialty providers from Facilities to Primary care.

  • Cactus - Provider Credentialing Software

  • Medhok - Grievance - software

  • Promise - system - Verification of benefits for Medicaid

  • CMS - novitas solutions

  • Microsoft Office -Excel,Word, Outlook, Powerpoint.

    
    

  
  

• Aug 2013 - Nov 2015
  Argosy University, Student Success Advisor

  Student Success Advisor

  
  

  • Oversaw 20–30 enrolled students each quarter, providing academic advising, retention support, and progress monitoring, while simultaneously conducting outreach to 100+ prospective students to drive new enrollment.

  • Delivered an estimated $264K in revenue per quarter by navigating students through the full lifecycle — financial‑aid processing, admissions requirements, and academic planning — functioning as a three‑pillar contributor across recruitment, advising, and financial services.

  • Led the university in starts February of 2014

  • Led the university in active recruitment applications.

  • Held a 95% retention rate from January 2015 to October 2015 of active students.

  
  

  
  

  Skills/Software

  • CampusVue/CampusNexus

  • Microsoft Office -Word,Outlook,Excel,Powerpoint.

  • Relationship management

  • CRM systems

  • Fafsa application/ financial education.