Karen Frazier Moore

About Karen Frazier Moore

As the Director of Provider Network Operations at AmeriHealth Caritas, I oversee the provider data updates and implementation of healthcare reimbursement policies and guidelines for the Medicaid Managed Care program, ensuring quality, accuracy, and compliance with state and provider contract requirements. I have more than 20 years of experience in operations, building cohesive teams, client relations and program management, specializing in healthcare reimbursement and pharmaceutical and manufacturer support services.My core competencies include managing client relationships, resolving provider inquiries and complaints, monitoring claim performance KPIs and compliance, and implementing and launching new programs and services. I hold a Certified Revenue Cycle Representative (CRCC) credential from the Healthcare Financial Management Association (HFMA), which demonstrates my expertise and commitment to excellence in the healthcare revenue cycle.

Experience

1. Director, Provider Network Operations

   AmeriHealth Caritas

   Jun 2019 — Present · Raleigh-Durham, NC, US

   Responsible for oversight of ACNC provider data and healthcare reimbursement rules and address provider inquiries and complaints.• Work in conjunction with the Enterprise Claims Department to ensure all contractual claim requirements are met with quality and consistency.• Monitor claim related contractual requirements to ensure compliance and oversee remediation plan for any non-complying areas.• Ensure all provider reimbursement (configuration) documentation is completed timely and accurately, in accordance with State and provider contract requirements.• Serve as subject matter expert in State specific health reimbursement rules and provider billing requirements.

Education

• University of North Carolina at Greensboro

  Bachelors, Human Environment and Business

  1982 — 1986

• University of Maryland Global Campus

  MBA, Business and Healthcare Administration

  2010 — 2013

Skills

• Program Management
• Accounts Receivable
• U.s. Health Insurance Portability and Accountability Act (Hipaa)
• Invoicing
• Health Insurance
• Managed Care
• Management
• Revenue Cycle
• Healthcare Industry
• Employee Benefits
• Process Improvement
• Analysis
• Medicaid
• Healthcare Reimbursement
• Healthcare
• Hipaa
• Business Process Improvement
• Insurance
• Training
• Cross-Functional Team Leadership
• Leadership
• Operations Management
• Employee Relations
• Oncology
• Policy
• Software Documentation
• Healthcare Management
• Medicare
• Customer Service