As a subject matter expert and leadership team member in Individual Membership Accounting, I ensure the accuracy and compliance of enrollment, billing, and reconciliation processes. I audit Membership Accounting Specialists’ work using statistically valid sampling, manage routine adjustments, and operate across key platforms including Facets CRM, SEED (SBM-FP platform as Oregon moves to a state-run platform), and Microsoft Office.
I monitor quality trends, conduct targeted audits, and deliver actionable reporting at both the individual and departmental levels to drive continuous improvement. My analysis supports strategic decisions that enhance operational efficiency, accuracy, and compliance with internal standards and regulatory requirements.
In addition to leading audit initiatives, I contribute to process documentation, support quality improvement efforts, and foster a collaborative team environment. Currently, I lead the Financials Workgroup and manage the BERP (Billing Entity) Report at Moda Health, which identifies billing anomalies and flags potential fraud or misrepresentation in claims—reinforcing financial integrity and oversight.More...