Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary
With broad experience implementing a variety of programs contributing
towards achieving company profitability goals, I have the ability to assess and
resolve a wide range of issues and am results oriented. I am highly effective in partnering with
managers and employees and identifying initiatives, areas requiring improvement
and implement appropriate resolutions. With strong
interpersonal and customer service skills, I have the ability to work accurately
to meet deadlines and maintain an effective working relationship with patients
and clinic staff. My computer skills include but are not limited to, Microsoft
Word, Excel, AND Outlook, PowerPoint, and Multiple EMR Systems. I type 55 WPM. Based on my
experience, knowledge, and ability to adapt to any job situation, I am an asset
to any company. I enjoy and take a great deal of pride in the work I’m
performing. I know I exceed what is expected of me in assuring the successful
operation of the company I work for.
Skills
Strategic planning capability
Planning and development
Analytical thinker
Accomplished leader
Supervisory training
Knowledge of Medicaid statutes and regulations
Medical terminology expert
Records management professional
Billing and collection procedures expert
Patient referrals expert
MEDISOFT proficient
Efficient and reliable team player
Medicaid Management Information Systems
Work History
10/2015 to 2016
Hedis Coordinator (Contract)Us Oncology, Inc. – Phoenix, AZ,
Work with multiple EMR systems such QSHR, HTA, Healthport, Altegra, ISET and ILead
Help vendors obtain medical records according to pend detail and measure
Excel workbench includes daily report run for daily activity
Schedule onsite and remote meetings to obtain medical records
Fax and follow up on providers with missing, incomplete or non-compliant charts and updating demographics
Following all measures for compliance of the NCQA (National Committee for Quality Assurance)
05/2015 to 10/2015
Credentialing/Provider Enrollment Alaris Group – Lubbock, TX,
Credentialing all billable and non-billable
providers
Maintaining each CAQH profile by keeping the application
current and within its 60 day grace period
Communication between all health insurance
companies to develop or maintain a relationship including Nationals, Group
contracts, and Local Plans
Develop and implement education and training
materials to facilitate payer-specific guidelines and diffused into practice
Monitor, interpret and deploy NCQA payer and
provider quality standards
Facilitates regular reporting to internal
departments, hospitals and headquarter leadership
Establish and maintain close working relationships
with hospital credentialing coordinators, network management, providers, and
payer contracts to expedite provider enrollment turnaround time
Plan and manage projects, budget and resource
allocation
Coordinate with Network Management to deploy health
plans
Validate provider enrollments with health plans and
coordinate with plans to ensure provider status is published and deployed to
mitigate denials for professional fees
Provide education with Care Management team to
Optimize Health plan resource utilization
Outlook Email,
Excel- Advanced, OneHealthPort Credentialing systems, CAQH
10/2014 to 05/2015
Licensing/CredentialingBillDME Licensing Manager – City, STATE,
Team leads all sales and staff on rule and regulation updates, including Stark Law and Safe Harbor Laws
Create policies and procedures for providers expecting inspection
LLC-CORP formation completion and follow-up
Licensing application completion and accurately inputted into EMR
Banking formation completion
Discussing contract with all providers of interest in becoming their own suppliers
Medicare and Medicaid Enrollment Process within Medicare guidelines
Registration on patients all over the USA Major Medical
Monitored all major insurance contracts for Doctors to become within the Network for DME
Build cases with Medisoft
Update Excel spreadsheets daily on all states and locations
Micro-manage all Licensing Departments
Chart reviews, prepare charts for billing cycle
Outlook Email, Excel-Intermediate, Powerpoint-Beginner, Word-Advanced, EMR - Sage Act
09/2013 to 04/2014
Patient Service CoordinatorInternal Medicine – City, STATE,
EMR-E-Clinical/Centricity/Athena
Verified and entered insurance information, including Medicare, Medicaid, Medi-pass, HMO, PPO and Availity
Worked with the Fax inbox sending each document to the correct doctor/nurse or manager Scheduled and monitored appointments through Athena/Centricity
E-Clinical Professional
Provide explanation of benefits EOBS, collect co-payments and coinsurance
Perform filing, faxing and type medical correspondence, scan all records into EMR-E Clinical systems
Type referrals for patients to see specialist
Reconcile end of month received cash/check/co-payments
Managing HEDIS Care Gaps, scheduling patients for Diabetic Education and all preventative care
Send Medical Records to insurance companies
Check patients in/out with follow-up and print visit summaries for meaningful use documentation
Credentialing the physician with all available insurance companies
Current to Current
Medical Administrative AssistantDr. Leopoldo Grauer (Externship) – City, STATE,
Schedule appointments, answer phones, transfer calls to appropriate personnel, take messages
Verify insurance, including Medicare and Medicaid
Provide explanation of benefits EOB/s and collect co-payments
Performed filing, faxing, and typed medical correspondence
Check inventory of office medical supplies, accurately listed supplies to restock
Check vital signs, blood pressure, height and weight, take patient's medical history and prepare patients for examination
Education
Expected in 2010
Associate of Applied Science: Medical Administration Everest University - Tampa, FL GPA:
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