MOUNT SINAI HEALTH SYSTEM PROVIDER SERVICES SPECIALIST
MS Office (Word, Excel, Power Point, Access, Outlook), Peachtree SQL basics
Certifications: Lean Six Sigma Green belt certified.
December 2016 to CurrentMount Sinai Health System Provider Services Specialist
Act as primary point of contact for Participating Providers within Provider Partners of Mount Sinai IPA.
Identifies and addresses provider file data set-up issues which impact claims problems and ensures that claims issues are addressed timely and accurately.
Conducts root cause analysis of any large claims projects submitted.
Performs routine evaluation of provider network performance including network adequacy and membership growth opportunities.
Have a thorough understanding of each Provider's contract and Payer arrangement, including care coordination, fee structure and physicians network.
Educate and ensure Providers are participating in meetings, clinical integration WebEx training sessions and other requirements of the CIN Program.
Collaborate with Sales/Marketing & Provider Recruitment departments to support campaign launches and ongoing recruitment efforts.
Participate in various QI committees and work groups to improve health care quality and member satisfaction outcomes.
Assist credentialing team with the health care plan enrollment process for the IPA Voluntary Providers, including: Gathering and reviewing enrollment requests, applications and contracts for completeness and accuracy.
Review regulatory changes and communicate updates to IPA's/Provider Community as needed.
Mount Sinai DSRIP PMOMarch 2016 to CurrentPartner Relations Specialist
Delivery System Reform Incentive Payment Program (DSRIP).
Serves as the liaison between the project management office (PMO) and partner organizations in the Mount Sinai Performing Provider System (PPS) in the areas of provider education and front line problem solving.
Monitor and assure regulatory documentation maintains corporate standards including contracts, business associate agreements and disclosures of protected health information (PHI).
Stay abreast of updates and new regulations from NYS DOH to ensure partners are on track for progress.
Work with partner organizations to assess current business models, operational workflows, and practice management systems to identify opportunities for improvement and efficiencies.
Develop and maintain positive relationships with partners to drive DSRIP goals; troubleshoots issues and provides timely follow up.
Help to design quality improvement initiatives, implement improvement interventions and evaluate the effectiveness of those interventions.
January 2015 to March 2016Maximus Quality Assurance Coordinator
Ensure employees are compliant with the healthcare compliance and business ethics policies and guidelines.
Analyze collected audit data to identify trends for staff re-training and implementing corrective action plans in collaboration with call center management staff.
Ensure that documentation produced and processed complies with state regulations and requirements.
Perform periodic compliance audits, risk assessments and conduct related ongoing compliance monitoring activities.
Assist in developing, producing and conducting compliance training programs.
Enter, transcribe, record, store, or maintain information in written, electronic and magnetic form relating to services, processes and quality systems.
Monitor the effectiveness and quality of incoming/outgoing calls made by enrollment counselors, as well as the effective of training received on product, services, system applications etc.
August 2012 to December 2014Maximus New York Medicaid Choice
Educate and enroll consumers to Medicaid Managed Care plans, Managed Long Term Care plans, FIDA and HARP program.
Analyze and evaluate results to provide consumers with the best solution.
Ensure that eligibility and enrollment services are compliant with federal, State, HIPAA and other regulations.
Work as company's primary mentor/trainer for the new employees.
Operate a multi-line phone system and heavy telephone support.
Assisting in all areas of administrative work including executive support, office management, and data entry and document preparation.
Education and Training
York College City University of New YorkMay 2012Bachelor's of Science: Business AdministrationBusiness Administration
Student Activities: York College Student Government Vice President, York College Bengali Club president; Meeting and event organizer
English, Hindi (oral) and Bengali (reading and writing)
administrative, call center, oral, compliance audits, contracts, data entry, Delivery, DOH, documentation, English, Government, Hindi, Marketing, meetings, mentor, Access, Excel, MS Office, office, Outlook, Power Point, Word, network, office management, organizer, Peachtree, phone system, policies, problem solving, processes, producing, progress, project management, protected health information, quality, quality improvement, reading, Recruitment, Sales, SQL, telephone, trainer, training programs, written