Well-organized, results-oriented operations leader, 10 years' experience in on-boarding, developing, and motivating high-performance team that consistently produces upwards results. Work extremely well alone or with team and groups from diverse backgrounds. Capable of handling every assigned task with accuracy and efficiency.
Skills
MS Word, Excel, Outlook
PowerPoint
CARZ
Care Radius
HCN
Citrix
52 wpm
Matter sight
Administrative, MS Word
AR, Coding
Benefits, Quality
Billing, Reporting
Citrix, Requirement
Coaching, Research
Cost control, Spreadsheet
Creative Problem Solving, Staff development
Credit, Strategic plans
Customer satisfaction, Strategic Planning
Database, Supervision
Diagnosis, Phone
Driving, Verbal communication skills
Filling, Workflow
Hiring, Written
Hub
HR
Insurance
Internal auditing
Inventory
Leadership
Team Leadership
Team Lead
Director
Managing
Medical Billing
Meetings
Mentoring
Excel
MS Office
Outlook
PowerPoint
Work History
Medical Operations Manager, 05/2017 to Current Pfizer – Bronx, NY,
Recruited, hired, and trained all staff, providing direct supervision, ongoing staff development, and continuing coaching and guidance to supervisors.
Established departmental organization, work priorities, workflow and team responsibilities due to change in workload, schedule changes or emergency situations and communicate to staff as necessary.
Acting back up in absence of a director, attended leadership meetings and made strategic plans for the department.
Made direct contacts with VA and worked side by side with them to better assist our veterans.
Provided training and support to VA with various procedures that impacted our veterans care.
Established and maintained working relationship with other hub, Providers and Peers throughout the organization.
Assisted providers to understand TriWest processing of claims requirement and assisted them to get their claims paid.
Maintained our position as the number#1 leading team for highest production and quality.
Ensured that we are in compliance with URAC Accreditation and adhere to relevant quality standards to improve the quality of care and services provided to our customers.
I make sure that employees are familiar with our policy and procedures, filling in any gaps of knowledge they may have and ensuring that the employees are taking all required trainings in a timely manner.
Medical Operations Supervisor, 01/2016 to 05/2017 Panjiva – Farmers Branch, TX,
Managed staff of 27 for my business unit and made sure staff is equipped to perform day to day tasks efficiently.
Trained and supported onboarding of new supervisors and continuous participation in hiring of agents and Team Leads and Supervisors for the department.
Supported Neo Hire Training class held remotely.
Represented leadership in the weekly Sacramento Hub Team Lead meetings and VA meetings to resolve issues/concerns and brain storm ideas to support the entire department.
Provide coaching, mentoring, performance evaluation to employees including disciplinary actions.
I encourage staff to learn and grow personally and professionally by coaching, mentoring and modelling leadership qualities and professional behavior.
Support the Director as an activing primary point of contact in absence of a Manager by monitoring the department's performance outcomes, driving training needs, resolving issues negatively impacting department performance and maintaining the TriWest culture throughout the department.
I partner with the administrative agent to come up with a plan for agent's productivity reporting and audit spreadsheet.
Lead Revenue Management Supervisor, 01/2010 to 01/2016 Coram CVS Specialty Infusion Services – City, STATE,
Manage staff of 32 for my business unit.
Address patient complaints, concerning in regards to billing or services rendered.
Responsible for hiring, coaching and terminating of employees following HR guidelines.
Manage all time off requests; call ins, disciplinary actions and time cards for team including self-evaluation assessment for each employee.
In charge of various payers including all Tricare accounts, Aetna, BCBS etc.
Hold escalation calls every week with Coram West (India) and provide feed backs and education whenever needed including HEMO AR calls for high dollar claims.
Review and validate adjustments/ increases.
Inclusive of obtaining and managing approvals for adjustments.
Perform internal auditing by reviewing insurance data for patient claims; process, research and correct accounts; verify diagnosis and authorization codes; identify liability and guarantors; review and adjust account balances; interpret Explanation of Benefits (EOBs); analyzes billing components.
Post payments and adjustments in billing/AR database ( Legacy).
Address issues impacting or impeding resolution of the Denial Variance, related to denials, underpayments, credits due.
Inclusive of: authorization issues, Secondary Payer, Credit Balances, assisting staff in rebilling and appeals.
Compile data and prepare reports for over 15K accounts that is sent to upper level leadership.
Review and approve payer, patient refunds.
Resolve issues which come via after hour's voicemail and review the phone tree log.
Team Lead, 05/2009 to 09/2010 Food Co Supermarket – City, STATE,
Inventory, ordering stocks for bakery dept.
In charge of the operation hours for bakery department.
Took action to ensure customer satisfaction, cost control and efficiency.
Education
Medical Billing and Coding program: , Expected in 12/2009 - , GPA:
High School Diploma: , Expected in 2009 High- Tech Institute - Rancho, Cordova GPA:
Diploma: Medical Billing and Coding, Expected in High-Tech Institute - Sacramento, CA GPA: Academic Excellence and Perfect Attendance
Best Leadership award
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