Carol Jeffries
Business Consultant @Independent Consulting
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WORK HISTORY
Business Consultant @Independent Consulting
Phoenix, AZ, US
Assess requirements and recommend avenues to streamline processes and reduce development/maintenance costs.
EDUCATION
Benton Central High School
HS Diploma
SKILLS
ABOUT CAROL JEFFRIES
30+ years of Healthcare, Medicaid, Medicare, HMO, CHAMPUS experience • 16 years Medicaid Management Information System (MMIS) Managing Fiscal Agent Operations • 13 years Medicaid Design, Development and Implementation (DDI) State projects. • 10 years hospital and multi physician practice clinical experience in medical records, insurance and collections. • 3.5 years Medicaid Pharmacy DDI • 1 year Medicare Part B Claims Manager. • 1 year CHAMPUS Fraud and Utilization Review Manager. • Reengineered 2 HMO Operations significantly reducing large claim volumes from backlog down to claims and account receivable inventory/delinquent accounts from $5mil to less than in a 10 week period • Test Manager for 3 MMIS and 1 Pharmacy DDI and 1 Prior Authorization Auto Approval project • Managed up to 100+ clerical, professional and technical personnel • Operations Project Manager for 2 Health Information Portability and Accountability Act (HIPAA) and Local Code Sets • MMIS Certification Project Manager Idaho following CMS Medicaid Enterprise Certification Toolkit (MECT) and Medicaid Information Technology Architecture (MITA) 2.0 federal guidelines • Director of 4 Project Managers for MMIS multi-state ICD-9 to ICD-10 conversion planning, assessment, coding/configuration and implementation • Medicaid Information Technology Architecture (MITA) 3.0 standard awareness • 2 years directing Medicaid Provider Re-validation planning, assessment, design, testing, training and implementing projects to meet CMS Affordable Care ACT (ACA) Provider Enrollment mandates • Healthcare Effectiveness Data and Information Set (HEDIS) quality measures analysis and resolution
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