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Program Coordinator Resume Example

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Jessica Claire
Montgomery Street, San Francisco, CA 94105
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary

Recently graduated in Heath Information Technology with deep expertise in data warehousing, process validation and business needs analysis. Proven ability to understand customer requirements and translate into actionable project plans. Dedicated and hard-working with passion for Big Data.

Skills
  • Process Improvement
  • Data oversight
  • Medical Insurance & Reimbursements
  • Project Management
  • Process Mapping
  • Data collection and analysis
  • Provider Network
  • Data Entry
  • HEDIS
  • Problem Resolution
  • Regulatory Compliance
  • Quality
  • ICD & CPT/HCPCS Coding
  • Computer Experience (MS Office Suite, Health Information Systems, Electronic Medical Records Systems, Encoder)
  • Case Management
  • Provider Relations
  • Medical billing and coding
Work History
11/2020 to Current
Provider Relations Specialist II Centene Corporation Moosic, PA,
  • Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
  • Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings 98.1%.
  • Answered 160 provider inquiries per quarter via email, telephone, written correspondence, and face to face meetings.
  • Initiated physician new provider orientations to support ongoing education of health care provider community with a focus on improving quality and financial outcomes within the provider network.
  • Identify network gaps and collaborated with PMPM initiatives and Continuity of Care to fill Care Gap deficiencies.
  • Generate reports detailing findings and recommendations.
  • Perform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create reports for provider. Review provider performance by both quantitative metrics and qualitative factors.
  • Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface.
  • Act as a liaison between the provider and health plan ensuring a coordinated effort in improving financial and quality performance.
08/2016 to Current
Program Coordinator Bethany Lutheran Homes Onalaska, WI,
  • Clients' Performed tasks necessary to promote member compliance such as verifying appointments, obtaining lab results, assess and monitor inpatient census.
  • Fostered professional networks and relationships with service and resource providers to promote continuity and quality of care.
  • Orchestrated smooth and efficient program development by collaborating cross-functionally across departments.
  • Reduced costs and improved operational performance without sacrificing quality by developing and implementing diverse approaches.
  • Maintained tight production timetables and quality standards to give audiences exceptional offerings.
  • Assessed current trends to assist with decision-making.
  • Developed and organized routine and special programming by factoring in slot timing, demographics, and other important parameters.
  • Determined customer needs and developed program initiatives according to preferences.
  • Assist in ensuring that all health metrics are met and are in compliance with state and federal guidelines.
  • Work collaboratively with other LHCC support team members, including case managers, peer support specialists, housing specialists, and SDOH coordinators.
01/2015 to 08/2016
Revenue Cycle Collections Specialist Concentra Louisville, KY,
  • Prepared and processed various insurance claims
  • Drove operational improvements which resulted in savings and improved profit margins.
  • Increased customer satisfaction by resolving claim issues.
  • Followed up with insured individuals regarding premium and deductibles payments.
  • Evaluated accuracy and quality of data entered into agency management system.
  • Review accounts receivable on a daily basis and performs follow-up on delinquent accounts according to established policies and procedures.
  • Research any error claims and make the necessary corrections for clean claim production and submission on an as needed basis.
  • Coordinated quality monitoring processes for claims including data collection, data analysis, and trend reporting.
  • Development and implementation of action plans for process improvement
  • Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
  • Resolved conflicts and negotiated mutually beneficial agreements between parties.
01/2014 to 01/2015
Cash Posting Specialist LHC Group Inc. City, STATE,
  • Reconciled account information and reported figures in general ledger by comparing to bank account statement each month.
  • Strengthened financial operations by conducting bank reconciliations and financial reporting.
  • Proactively identified all accounting errors by developing cross-referencing databases.
  • Managed and responded to all correspondence and inquiries from customers and vendors.
  • Entered financial data into company accounting database for verification and reconciliation, maintaining accurate and current accounts at all times.
  • Analyzed financial data derived from multiple reporting systems to develop recommendations for operational and performance improvements.
  • Implemented new accounting processes to decrease spending and work flow downtime.
  • Verified postings to ledgers to confirm accurate entry and account balances.
  • Performed end of month reconciliation by comparing accounts receivable report to collections journal; amount remittance advice amount and deposited amount.
  • Research charge backs and make final decision for write off.
07/2012 to 01/2014
Financial Intake Eligibility Specialist LHC Group Inc. City, STATE,
  • Communicated directly with individuals and families to provide information about eligibility requirements, application details, payment methods and applicants' legal rights during intake assessment.
  • Answered phone calls and provided new clients with required paperwork to initiate service.
  • Completed and filed financial documentation for accounting purposes.
  • Resolved conflicts and negotiated mutually beneficial agreements between parties.
  • Verified insurance eligibility and benefits for different payers to determined coverage on an in and out of network statuses on a daily basis in an accurate manner.
  • Interacted kindly with insurance providers via phone, email and written correspondence to obtain necessary documents to complete registration.
  • Assessed information gleaned from interviews, educational, and medical records, consultation with other professionals and diagnostic evaluations to identify clients' abilities, needs and eligibility for services.
Education
Expected in 04/2020
Associate of Science: Health Information Technology
Remington College - Lake Mary, FL
GPA:
Expected in 05/2009
: Medical Assistant Program
Remington College - Baton Rouge - Baton Rouge, LA
GPA:

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Resume Overview

School Attended
  • Remington College
  • Remington College - Baton Rouge
Job Titles Held:
  • Provider Relations Specialist II
  • Program Coordinator
  • Revenue Cycle Collections Specialist
  • Cash Posting Specialist
  • Financial Intake Eligibility Specialist
Degrees
  • Associate of Science

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