Livecareer-Resume
Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Management Profile
Ambitious Director of Operations Manager with more than 16 years of management experience in the Healthcare industry. Applies strong analytical and critical thinking skills to solve complex operational problems.
Skill Highlights
  • OB-GYN, Surgery, Gastro, Plastics, Derm and Radiation Oncology experience
  • Knowledge of HMOs, Medicare and Medi-Cal
  • Managed care contract knowledge
  • PPO & HMO Contract Negotiation/ Credentialing
  • Electronic Medical Record (EMR) software
  • Healthcare billing proficiency
  • Revenue Cycle Operations
  • A/R Clinic & Facility Collections
  • ICD-9 coding
  • Trained in ASC Coding
  • CPT and HCPCS coding
  • Appeal/Denial Letters
  • Posting & Adjusting of Insurance EOB’s
  • Staff training and development
  • In-depth claims knowledge
  • Claims analysis and review specialist
  • Extensive EHR experience
  • Medical Assisting specialist
  • Hiring and retention
  • Human Resources Management
  • Compensation/payroll
  • Regulatory compliance
  • Personnel records maintenance
  • New hire orientation
  • OSHA inspections
  • Direct marketing campaigns
  • Cost reduction and containment
  • Multi-site operations
  • Systems implementation
  • Service contract review and recommendations
  •  Fiscal Management
  • Sales and Market Growth
  • Start-up Business Development
Education
University of Phoenix Los Angeles, CA Expected in 2012 MBA : Healthcare Administration - GPA :
University of Phoenix Los Angeles, CA Expected in 2010 Bachelor of Science : Healthcare Administration - GPA :
Core Accomplishments
Staff Development:
  • Launched well-received program of professional development courses for all staff.
  • Mentored and coached employees resulting in a 12% increase in productivity.
Human Resources:
  • Spearheaded new Customer Retention program which increased profit by 25%.
Implementation
  • Assisted in implementation of new EHR system that resulted in improved patient care.
Professional Experience
Related Companies - Director of Operations
Harbor City, CA, 2012 - 11/2015
 
Business Operations
Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines. Supervised and evaluated the activities of medical, nursing, technical, clerical, maintenance and other personnel. Jumped in to fill gaps for Medical Assistants, Surgery Schedulers and Front Office when necessary. Diligently monitored the QA (Quality Assurance) program to improve performance and maintain high standards of care. Minimized staff turnover through appropriate selection, orientation, training, staff education and development. Established and maintained positive relationships with government regulators, other area health care providers, physicians and community at large. Organized and led weekly personnel meetings with 25 team members. Developed and managed budget and revenue expectations while actively seeking ways to eliminate or reduce expenses. Revised policies and procedures in accordance with changes in local, state and federal laws and regulations. Established facility\'s annual budget and conducted monthly reviews to ensure finances were being properly allocated. Monitored infection control procedures to ensure facility-wide health and safety. Developed and arranged continuing education opportunities for all staff to increase knowledge and skills.
  
Billing/Financial
Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy. Accurately entered procedure codes, diagnosis codes and patient information into billing software. Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative. Thoroughly reviewed remittance codes from EOBS/AR\'s. Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature. Completed appeals and filed and submitted claims. Applied payments, adjustments and denials into system. Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables and clearing house. Meticulously tracked and resolved underpayments. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans. Handled cash and deposits using the proper accounting procedures and documentation. Processed bank reconciliations and financial reports to verify practice of proper due diligence.
 
Human Resources
Recruited, trained, mentored and fired employees. Conducted new employee orientation to foster positive attitude toward organizational objectives. Designed training modules that implemented strategic business practices and organizational behavior training concepts. Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed. Processed payroll and employee pay adjustments.
 
Contracting / Credentialing
Prepared, reviewed and process all credentialing and re-credentialing applications for all providers employed by and/or contracted with associated with practice.  Maintained current and obtain updated insurances agreements/contracts/ licenses and certifications, etc, related to credentialing. Ensured all insurance carriers are up today on all of changes and updates made to providers or groups.
Related Companies - Director of Operations
Irving, TX, 01/2008 - 05/2011
 
Business Operations
Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines. Monitored scheduling, registration, verifying insurance, insurance authorizations, coordination of required medical and financial information. Medical Records management, and scheduling of office staff. Supervised and evaluated the activities of medical, nursing, technical, clerical, service, maintenance and other personnel. Jumped in to fill gaps for Medical Assistants, surgery schedulers and Front Office when necessary. 
 
Operations of Ambulatory Surgery Center
Planned, directed and monitored regulatory operations. Involvement of the entire process of opening a AAASF Ambulatory Surgery Center (from build out to AAAASF accreditation) Managed the departments of nursing, central supplies, medical records, and housekeeping, and supervised the contracted services of Biohazard, pharmaceuticals, laundry, and biomedical engineering etc. Directed, planned, coordinated, and monitored all operational and financial aspects of the Surgery Center, in conjunction with providing effective leadership to staff and overseeing the delivery of quality, cost-effective patient care Directed and coordinated clinical, regulatory, administrative, and distribution activities of the surgery center Maintained Ambulatory Surgery Center certification through conducting quarterly Quality Assurance meetings regarding Surgery Center regulations Administered the infection control program and medical staff review of the quality improvement program Collaborated with the Medical Director in the review and revision of the Medical Staff Bylaws, Rules, and Regulations on a biannual basis. Negotiated and controlled all external contracts, ancillary services and purchasing agreements.
 
Billing / Financial
Using coded data to produce and submit claims electronically to insurance companies. Worked directly with the insurance company, healthcare provider, and patient to get a claim processed and paid. Reviewed and appealed unpaid and denied claims. Handled collections on unpaid accounts. Managed and monitored the facility’s Account Receivable reports. Answered patients’ billing questions.
Intermountain Healthcare - Ambulatory Surgery Center Administrator
Tooele, UT, 03/2003 - 01/2008
 
Operations of Ambulatory Surgery Center
Directed, coordinated, and controlled all aspects of the operating functions, processes, and staff of the ambulatory surgical center. Served, as a liaison between the professional standards committee, medical staff, and all departments of the center. Maintained and update Business Office Policies and Procedures. Conducted departmental meetings. Assured quality customer service to physicians, physician office schedulers and managers, surgery center staff, patients and their families. Attended Medical Advisory Meetings, Board Meetings and Committee Meetings as requested. Maintained accurate minutes for all meetings as requested. Maintained Peer Review, Nursing Audit and Infection Control files. Participated in preparation of budget that will allow for adequate personnel, supplies and equipment. Maintained surgery center supplies. Participated in Quality Improvement Activities; assists in developing quality reports. Oversaw IT Support and maintenance of office equipment. Credentialing all new providers and maintained up-to-date files. Maintained company website. Updated activity report in excel weekly. 
 
Accounts Receivable
Collected up-front patient co-pays. Timely posting of payments. Posted and deposit of daily receipts.
 
Staffing, Training and Supervision
Interviewed and hired personnel as needed due to staff changes. Monitored and covered staffing for all surgical cases. Provided proper orientation, trained and ongoing education to new staff. Counseled and disciplined employees when necessary. Evaluated and communicated employee job performance through observation of individual productivity, punctuality, efficiency, accuracy and adherence to policies and procedures. Conducted personnel evaluations for employees supervised.
 
Scheduling and Registration
Maintained surgical schedule; worked closely with Clinical Director for efficient and accurate scheduling. Timely pre-verification of patient insurance coverage. Chart preparation. Developed relationships with physician schedulers and office managers. Ensured efficient patient registration.
 
Medical Records/HIPAA
Maintained complete and accurate records. Complied with state and federal guidelines. Insured proper medical record storage and retrieval. Processed medical record requests/disclosures in accordance with federal privacy laws. Oversaw and managed dictation. Maintained strict confidentiality in regards to patient account status.
 
Billing
Surgery Center billing and coding. Evaluation of billing and collection activities. Monitored patient accounts. Worked with payers through claim processing to ensure accurate reimbursement. Ensured collections are accurate and up to date. Payment posting. Worked appeals and claim adjudication. Analyzed financials of practice.
 
Accounts Payable
Reconciled all front-office invoices (supported by purchase order)
 
Human Resources
Submitted payroll information for each pay period. Maintained complete and accurate personnel records for employees and medical staff.
 

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Resume Overview

School Attended

  • University of Phoenix
  • University of Phoenix

Job Titles Held:

  • Director of Operations
  • Director of Operations
  • Ambulatory Surgery Center Administrator

Degrees

  • MBA
  • Bachelor of Science

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