Sylvia Raines

Sylvia Raines


The company I worked for, for 16 years, Prison Health Services, reorganized and combined the Managed Care department with the Claims Department. Unfortunately my position was eliminated in 2004. I was fortunate to be able to take some time off, but due to the current economic situation, I am now in need of full time employment and very eager to be part of the work force again.

I have always enjoyed all processes in the medical claims field. I would like to resume my employment in this area. 

I am a very detail oriented and analytical person with great work ethic and loyal to any company I work for.

Thank you for your time and I hope to hear from you. You may contact me either by telephone or email.


Associate Accountant with significant background in accounts payable, medical claims processing, inventory reconcilement to general ledger and general ledger journal entries. Detail oriented with excellent analytical skills. Very dependable and possess ability to complete multiple tasks within allotted time. Excellent customer service skills. Extensive knowledge of HCFA-1500/UB92 (Cpt/Hcpc/Revenue/ICD-9 codes), medical claims repricing per Medicare/Medicaid fee schedules and unique Provider Contracts (discounts, stop loss, DRG’s, APC’s, etc.). Fluent in Dutch, some German and French. Computer literate.


Mainframe As-400, Macola, Microsoft Windows, MS Word, Excel, Outlook, Power Point, Proprietary Claims system.


Golf, cooking, animals


Seeking a clerical position in the healthcare industry

Work History

Work History
Nov 1988 - Mar 2004

Medical Claims Manager

America Service Group/Prison Health Services Inc


2051 Paradise Drive

Lewisburg, TN 37091

(931) 270-1808 (H)

Prison Health Services, Inc., Brentwood, Tennessee1997 - 2004

(Subsidiary of America Service Group, Inc.,provider of correctional healthcare services).

Corporate office relocated from Delaware.

All areas of Medical Accounts Payable

§Monitored conversion from proprietary Claims Processing system to Outsourcing Company

§Audited approximately 3000+ claims per week to ensure accurate payments per Provider Contracts

and terms, and regional Medicare, Medicaid fee schedules, for check runs from $4-5M per month.

§Reviewed Cash Requirements/Pre Check Writing Report prior to payment

§Assisted in conversion from Outsourcing Company back to proprietary Claims Processing System;

suggested and had modifications implemented where needed

§Managed claims processing staff of approximately 15-20, from receipt of HCFA 1500/UB 92 to payment,

for an approximate Average Daily Prison Population of 217,000

§Maintained Database for Provider Contracts to ensure accurate and auto adjudication of claims

§Month end reports, or as needed per Clients’ or sites’ requests

§Monitored and evaluated staff performance; recommended annual salary increases

Prison Health Services, Inc., New Castle, Delaware12/5/1988 - 1997

(Subsidiary of America Service Group, Inc.)

All areas of Medical Accounts Payable/Accounts Payable

§Processed medical claims/vendor invoices for approximately 10,000 inmates

§Processed payments to providers/vendors, utilizing proprietary software and mainframe AS-400

§Investigated/resolved exceptions by interacting with providers, vendors, site personnel and upper


§Designed and implemented filing system for accounts payable department and organized year end storage

of accounting files

§Facilitator of team communication, customer service liaison, coordinated team work flow, monitored

and reviewed team work progress

§Managed monthly medical and vendor accrual process

§Maintained medical database and tested modifications

§Managed training of new staff members

§Designed and implemented procedures for reconciliation of pharmacy system to general ledger

§Assisted with design and implementation of modifications to existing computer program for remote

data entry

§Processed, reviewed and analyzed monthly medical accrual reports and related journal entries

§Provided support to accounts payable staff of 9 clerks in terms of database use and operational questions

§Monitored, analyzed and modified departmental procedures to enhance efficiency

§Reviewed voucher packages prior to payments to providers to ensure contractual agreement

§Monitored and evaluated staff performance; recommended annual salary increases

§Reported all issues related to accounts payable to senior management




Various training and workshops


·Military correspondence course, Berlin Brigade Army Education Center.

·Principals of Banking course, Wilmington, Delaware.

·Tax Consultant course, National Income Tax Service, Wilmington, Delaware.

·Introduction to D-Base III plus course, Delaware Technical and Community College, Wilmington, Delaware.

·Dun & Bradstreet Supervisor's Workshop seminar, Wilmington Delaware.

·Outstanding Phone Service Workshop.

HS Diploma

Gemeentelijke Pedagogische Akademie


Schoevers Secretarial/Accounting School
Jul 2004 - Nov 2004


AHP – At Home Professions - Medical Claims and Billing