1. SENA JOLLIFFI
18467 Hartwell
Detroit, MI
(248)808-7995
PROFESSIONAL SUMMARY
 Skilled dedicated 25 year healthcare professional with a versatileadministrative skill-set
developed as an office manager, claims processing supervisor, administrative assistantand
quality assurance tester.
 Extensive experience in resolving employer challenges with innovative solutions, systems
and quality improvements proven to increase efficiency, customer service and provider
satisfaction within the revenue cycle.
 Proficient in government based, private, and supplemental insurances plans such as:
Medicare, Medicaid, Marketplace, BCBS, Commercial, Auto, and Worker Compensation
insurance.
TECHNICAL SKILLS
Skills: Medicare, Advance MD/HER, Medical Terminology, Business
Management, Quality Assurance, Staff Development & Training,
Teambuilding & Supervision, Claims Processing Policies &
Procedures Manuals, Corporate Compliances, Membership
Reconciliation, Epic, Charge Capture/Recovery, Member
Eligibility/Enrollment, SharePoint, Kronos Pay Systems, Web
Denis/Nasco, ICD 10/CPT coding, Microsoft Windows
Access/Excel/PowerPoint/Workflow/QNXT, Microsoft Visio,
Medicare C Snap/WebStrat/ Redbook/ Encoder
PROFESSIONAL EXPERIENCE
Molina Healthcare- Detroit, MI November 2014 to Present
Claims Supervisor
 Monitor Claims Processing guidelines and policies for Claims Department for all aspect of
government health plans as well as actively assist and provide directions for multiple states.
 Provide resolution to internal and external issues.
 Assume responsible for the quality and production along with maintaining high work ethics
with accuracy and quality
 Responsible for meeting monthly fiscally responsible.
 Collaborates with all levels of personal concerning the Molina Standard and policies
 Take part in recruiting, interviewing and hiring candidates.

2.  Establish staffing to support business needs as will business objectives where production
and quality concerns with the health plans
 Demonstrate operational and analyticalcapabilities to meet company internal personnel and
external vendor’s needs.
 Support other operational departments to meet business goals such as: Configurations,
Adjustments, and Provider Services.
 Prepare and contribute information to action plans to implement a better productive, quality
and customer service standard.
Accomplishments:
 Led the only team that was ever designated the “A” Team for consistently exceeding
Production and Quality goals set by the Organization
 Mentored and developed direct reports which resulted in several of them being promoted to
different positions
 2 Trainers, 5 Supervisors and 3 Team Leads.
 Trusted as the only highly regarded liaison between Detroit and the Corporate Headquarters
Tenet (Entech) - Commerce Township, MI May 2014 to November 2014
Quality Coding Auditor Medical Group
 Maintain claims processing and coding correction for 8000 doctors within health system
 Review, Revised and Delegate claims that were mishandled by the departments.
 Responsible for maintaining strict adherence to Health Insurance Portability and
Accountability Act compliance
 Provide training and updates concerning changes in Medicare, Medicaid, and other
insurances
 Responsible for department’s matrix’s-Production, Quality and other department and
organizational goals.
 Work with rejection and denials associate with contract disputes.
OnHealthcare, Troy MI January 2012 to April 2013
Ancillary Products Manager
 Monitor the operations and development of the Durable Medical Product offered for nine
states.
 Continue to develop training procedures to improve workflows and distribution of the
Durable Medical Products department.
 Assisted in converting Excel workflow spreadsheets to SharePoint for a more user-friendly
tracking for products warranties.
 Create a guidelines for necessary information needed to properly bill for our products to
state and federal payers in the state we operate in.
 Continually monitor and develop improvements to the submission of documents that are
submitted by third party vendors and Skilled Nursing Facilities.

3.  Continually improving the ring and deliveries of the DME product to the Skilled Nursing
facilities.
 Create business methodology to reduce billing and ordering discrepancies.
 Update staff of changes to any Federal and State funded programs, work plan, and reports
status; within the six states we supply Audiology, Podiatry, Dental, and Ophthalmology
services.
 Schedule training for conflict resolution for Technicians, Schedulers, and Coordinators with
patients and providers.
 Audit facilities that we services to evaluate of customer service and the quality of our
product.
Health Business Solutions – Dearborn, MI October 2010 to April 2013
Coder
 Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures.
 General virtual supervision, customarily and regularly exercises discretion and independent
judgment to assigns diagnostic and procedural codes to patient charts of moderate to high
complexity using ICD-9-CM, CPT and HCPCS or any other designated coding classification
system in accordance with coding rules and regulations.
 Abides by the Standards of Ethical Coding
 Responsible for maintaining coding data quality and integrity for all coding assignments...
 Review inpatient medical records to validate the admission order, assignment and sequencing
of ICD9-CM diagnosis and procedure codes, discharge status codes, and DRG assignment
 Comply with prescribed audit productivity and quality standards
 Understanding of Medicare/ Medicaid and commercial provider reimbursement
methodologies and possess strong data analysis skills
 Created particular practices as standard operational procedures for insurance billing
 Trained billing team on basic procedures for aged claims and coding issues.
Detroit Medical Center – Detroit, MI January 2010 to January 2012
Patient Management Coordinator
 Worked employer insurance from the payer side. Responsible for processing all risk
management claims for hospital employees and all other claims for the Detroit Medical
Center.
 As a Patient Manager, supervised a staff of more than 21.
 Skillfully developed departmental goals, objectives, and standards of performance, policies
and procedures.
 Organized the department in accordance with administrative guidelinesin order to provide
specified nursing services to meet the legal, organizational and medical staff guidelines
 Consistently complied with applicable laws and regulations and ensured facility adhered to
Medicare and Medicaid regulations
 Educated staff on state and federal statutes, rules and regulations governing for therapy
services.

4.  Developed and achieved financial and growth goals
 Oversaw private and Medicare and Medicaid billing, payroll, AP, and AR and verified that
proper procedures were followed.
 Encouraged creative thinking, problem solving, and empowerment as part of the facility
management group to improve morale and teamwork.
 Routinely collaborated with department managers to correct problems and improve services.
 Achieved high staff morale and retention through effective communication, prompt
problem resolution, proactive supervisory practices and facilitating a proactive work
environment.
Detroit Medical Center – Detroit, MI January 2008 to January 2010
Patient Account Representative
 Developed efficiency-enhancing workflow/process improvements that made it possible to
accommodate increasing responsibilities necessitated by staff reductions through the using
of Excel spreadsheets.
 Coordinate effective training techniques for Medicare to improve billing and registration
procedures.
 Support and maintain reports on the teams work flow, analyze the progression of their
patient visit.
 Report the metrics of the office visit in comparison with the years before.
 Handle Third Party Liability investigation after Medicare.
 Correct claims through the Facet system and Webdenis.
Henry Ford Health System (Robert Half), Troy MI January 2005 to December 2005
Billing and Insurance Follow up Representative
 Resolved Medicare, Medicaid primary and COB issues consider Auto, WC, and other liability
claims.
 Researched rejection for In/Out patient accounts with non-covered charges and charges
patient signed consent to be responsible party at the time of service.
 Billed all areas of hospital claims such as: Specialty Services, Professional, ER, Therapy,
Vision, Liability, TMJ, and Podiatry.
Botsford Hospital, Farmington Hills MI November 2001 to January 2005
Billing and Insurance Follow up Representative
 Review and process claims in accordance to state and federal regulation using appropriate
ICD-9, CPT and HCPCS code for Medicare, Medicaid, Commercial, and Supplemental
Insurances
 Submit any additional medical records, therapy notes and scripts that may be require
adjudicating claim.

5.  Responsible for daily maintenance of the Medicare FSS, Web Denis FCC (HEDIS), and
Medicaid Champs for correction of claims.
 Monthly reconciliation of PT, OT, and SP claims that are billing on cycle basic.
Jawood & Associate, Southfield MI March 1998 to November 2001
Billing Analyst
 Review and analyze billing operation reports for Blue Cross Blue Shield of Michigan.
 Produce statistical data for mainframe to pay appropriate reimbursements and proper patient
responsibility amounts such as: deductibles, coinsurances, and copays.
 Report new products and programs to improve quality and customer service.
 Implemented strategies Nasco benefits based clients for new contracted. Created test claims
to make sure reimbursements for co insurance and cost share and deductibles.
 Worked Nasco mainframe Facet.
 Nasco knowledge of benefits for company contracts such as: Old Kent Bank, Ford, and
General Motors.
Omnicare (Insurance Overload), Detroit MI June 1996 to March 1998
Claim Adjudicator
 Reconcile outstanding Detroit Medical Center claims.
 Ensure proper reimbursement was applied using HMO fee schedule.
 Review medical documentations for COB and any liability claims.
PPOM/Confinity, Southfield MI January 1993 to June 1996
Hospital Specialist
 Responsible for daily preprocessing of hospital, urgent care, and ER claims.
 Responsible for claim processing audits concerning month end.
 Audit team members claim accuracy.
EDUCATION
Marygrove College, Detroit, MI 2003
 Top 10% of class
 Medical Billing and Coding Certificate August 2011
 Medical Terminology and Computerized Medical Billing (100-A)
 Medical Advanced Hospital Coding (96.81-A)
 Commission on Accreditation of Healthcare Management Education