BuffMarioPls User
@buffmarioplsuser
I improve provider relations, claims operations, and regulatory compliance across managed care.
United StatesWhat I'm looking for
I'm currently advancing provider compliance and network accuracy at Parkland Health, leading TMHP PEMS Revalidation, CLIA Certification, and Electronic Visit Verification reporting initiatives.
I serve as an escalation point for claims, reimbursement, and contract issues while conducting 40+ provider site visits each month across the Dallas Service Delivery Area. I work with providers, compliance teams, and cross-functional partners to resolve issues and improve processes.
Across Parkland Health, HCSC, Global Medical Response, Children’s Health Systems of Texas, and Molina Healthcare, I've managed provider services, Medicaid claims operations, payroll and workforce compliance, provider education, audits, and reimbursement issues. I bring more than 10 years of managed care, provider relations, and claims operations experience.
Experience
Work history, roles, and key accomplishments
Lead TMHP PEMS Revalidation and CLIA Certification initiatives, ensuring compliance with state and regulatory requirements. Conduct provider site visits and serve as point of contact for escalations involving claims, reimbursement, and contracts.
Managed onboarding processes and audited I-9 documentation to ensure compliance. Analyzed workforce data to support planning and led outreach initiatives during national weather emergency events.
Processed payroll adjustments, wage garnishments, and audits. Analyzed payroll data and resolved discrepancies with HR teams.
Managed claims operations for Medicaid lines of business (STAR, CHIP, STAR Kids). Served as liaison to provider networks and resolved complex reimbursement and quality issues.
Supervised claims team supporting provider inquiries and appeals. Educated providers on contracts, billing, and processes, and improved workflows.
Education
Degrees, certifications, and relevant coursework
BuffMarioPls hasn't added their education
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Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
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Job categories
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