Principal Access Representative Resume Example University Of California, Davis Comprehensive Cancer Center

PRINCIPAL ACCESS REPRESENTATIVE

Professional Summary

Quality Assurance Project Management Project Implementation Risk/Contingency Management Medicare, Medicaid Policy, Procedures and Regulations CPT, ICD, HCPCS, DRG, RBRVS billing and coding

Skill Highlights

Payor and Financial Coordinator
Highly experienced healthcare professional with analytical expertise in developing effective case management negotiations and approvals. Extensive experience in creating strategies and processes to enhance patient services and improve access and delivery. Broad understanding of project implementation and business functions that impact department success. Diverse knowledge of accounting, financial concepts, payor case agreements with health plans and health care reimbursement. Strong leadership and mentoring skills. Expert level knowledge of insurance and specialty contract cases; ten years of experience in health care operations and services. Articulate oral and written communication skills; ability to quickly engage and motivate team members, establishing rapport and developing strong working relationships resulting in resolution of issues and improvement in team cohesiveness and overall performance. Conducting presentations in delivering complex information to diverse audiences and groups with supportive findings. Three years of progressive responsibility and operational leadership within a comprehensive cancer center and multiple specialty physician clinic.
Strengths and Core Competencies
Specialty and Single Case Management
Insurance Terminology
Medical Terminology
Professional Fee and Facility Fee Reimbursement
Training/Mentoring
Leadership
Critical Analysis
Strategic Project Analysis
Microsoft Word, Excel, PowerPoint, Access, Outlook, EPIC, People Soft

Professional Experience

Principal Access Representative01/2014 to CurrentUniversity of California, Davis Comprehensive Cancer Center

Facilitate all stem cell transplant contract and payor case management Submission of clinical information to corresponding health plans and outsourced specialty case management companies such as Optum, Interlink, and LifeSOURCE Case creation in adherence to Medi-Cal/state and FDA guidelines for authorization and claims reimbursement for stem cell transplant services Management of appropriate documentation and clinical submission for continuing and concurrent review for insurance/contractual cases Design and create proposals for strategic initiatives for Cancer Center Launched and manage tracking for incoming patient access and statistical analysis to include payor type for comparison Analysis, retrieval, and management of clinical data from a variety of health care software systems to create reports for local and federal governing agency specific audits.

Medical Office Service Coordinator III01/2013 to 01/2014University of California, Davis Comprehensive Cancer Center

Oncology referral disease review for multiple specialty physician oncology center Urology oncology referral case review and assignment Training and mentoring peers Contribution to successful streamlining pilot program for external records retrieval services Performed and conducted special projects as assigned to support supervising manager.

Medical Office Service Coordinator II01/2012 to 01/2013University of California, Davis Comprehensive Cancer Center

Patient registration and referral intake Creation of policies and procedures handbook for new staff orientation Document drafting and reports for referral tracking and data compilation Maintained effective working relationship and communication with providers to ensure timely access for patients Recognition and achievement for excellence in thought leadership and collaboration.

Lead Patient Care Coordinator and Surgery Coordinator01/2005 to 01/2012Sutter Medical Foundation RAS, Urology Associates of Northern California

Recruitment, orientation, training and mentoring staff as clinic lead to support organizational growth Developed strategy and training that streamlined patient access to ensure patient satisfaction by implementing health information exchange procedures Revised and improved office policies and clinic operations Surgical case coordinator and liaison for insurance payors, facilities and providers Drafting and development of surgical consents to meet protocols Extensive training in urology oncology disease process and outcomes Outstanding knowledge of insurance plans, terminology, coverage detail, and eligibility Completed HIPAA compliance training and certification.

Education and Training

Bachelor of Science: Health Administration and Management2012University of Phoenix College of Health Sciences and NursingHealth Administration and Management

Skills

accounting, Articulate, agency, Cancer, Case Management, oral, delivery, documentation, Drafting, Financial, Insurance, Leadership, Medical Terminology, Mentoring, Access, Excel, exchange, office, Outlook, PowerPoint, Microsoft Word, negotiations, Oncology, organizational, People Soft, policies, presentations, processes, Project Analysis, proposals, protocols, rapport, Recruitment, statistical analysis, strategy, Strategic, supervising, type, Urology, written communication skills

Resume Overview

Companies Worked For:

University of California, Davis Comprehensive Cancer Center
Sutter Medical Foundation RAS, Urology Associates of Northern California

School Attended

University of Phoenix College of Health Sciences and Nursing

Job Titles Held:

Principal Access Representative
Medical Office Service Coordinator III
Medical Office Service Coordinator II
Lead Patient Care Coordinator and Surgery Coordinator

Degrees

Bachelor of Science : Health Administration and Management 2012

Principal Access Representative Resume Example

Resume Score: 90%

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