LiveCareer-Resume

provider executive resume example with 20+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Summary

I am searching for a role in healthcare because I am passionate about people, their health, and teamwork. I want to make an impact on my community by creating a seamless healthcare experience for people that eliminates organizational failure in times when they need clarity and compassion. I accomplish this by striving to model servant-leadership for my team and clients, paired with over 20 years of experience in revenue cycle operations, staff development, and leadership Forward-thinking [Job Title] proficient in generating high-quality [Type] work. Talented at leveraging tenacious approach and strong attention to detail to drive success. Service-oriented and performance-driven with excellent organizational, multitasking and problem-solving abilities.

Skills
  • Operations oversight
  • Client/patient-oriented
  • Growth planning
  • Client account management
  • Leadership/communication skills
  • Networking abilities
  • Provider Relations
  • Team development and training
  • Project Management
  • Revenue Cycle Operations
  • Decision-making
Experience
Provider Executive, 10/2014 to 12/2020
Aln Medical ManagementLincoln, NE,
  • Developed and maintained strong, positive relationships with key providers in an assigned region.
  • Responsible for facilitating, supporting, and coordinating strategic initiatives with key providers in support of improved quality and efficiency of care.
  • Influenced key healthcare organizations to participate in collaborative initiatives that are mutually beneficial.
  • Severed as a resource to, and partner closely with internal departments that support the work of key external providers.
  • Facilitate resolution of escalated or urgent provider issues that are unable to be resolved through standard processes/procedures.
  • Serve as liaison to providers regarding contracting issues and ensure consistency with compensation strategy.
  • Build and maintain positive physician/hospital relationships with key organizations with a focus on a collaborative approach to quality care, network development and stability, cost containment, and the identification and resolution of barriers to success.
  • Demonstrate knowledge and support of corporate initiatives related to provider’s engagement, quality and efficiency of care, and prioritize work activities to support them.
  • Develop and deliver provider education regarding BCBS directives, mandates, reimbursement methodologies, medical policy, agreements, programs and business needs.
  • Develop the Nebraska provider network to include providers needed for product success and network adequacy.
  • In collaboration with internal partners, provide value-added consulting and solutions to assigned providers. This includes trends, variances, and outliers in populations, determining root causes of these variances, and summarizing in understandable terms. This may also include presenting at educational conferences, submitting data to newsletters, and providing classes for the provider community through on-site training or educational webinars.
Medical Billing Manager, 01/2010 to 07/2014
Acadia HealthcareLebanon, NH,
  • Managed 10 large practice accounts at once.
  • Managed the billing staff
  • Participated in educational opportunities, including workshops, seminars and training classes to gain a stronger education in industry updates and federal regulations.
  • Addressed and responded to staff and client inquiries regarding CPT and diagnosis codes.
  • Applied HIPAA Privacy and Security Regulations while handling patient information.
  • Enforced compliance with organizational policies and federal requirements regarding confidentiality.
  • Oversaw day-to-day operations of billing department, including medical coding, charge entry, claims
  • Compiled financial data for each practice and presented the information to each practice's board or provider group
Revenue Cycle Manager, 12/2004 to 06/2009
Universal Health ServicesNorth Charleston, SC,
  • Analyzed and reported on billing cycle data to inform management.
  • Evaluated revenue cycle processes and established actionable methods to increase productivity and efficiency.
  • Oversaw complete lifecycle of revenue operations.
  • Provided revenue cycle process support to all clinical personnel, including resolving procedure challenges.
  • Onboarded new groups to the organization
  • Implemented new billing software, trained all staff on how to use
  • Managed several provider offices and front office staff
Coder, 05/1995 to 12/2004
Nebraska Internal MedicineCity, STATE,
  • Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
  • Responded to coding questions from callers and other internal departments.
  • Collected documentation and clarified ambiguous patient care statements by contacting providers.
  • Reviewed clinical data from medical records to assign ICD, CPT and HCPCS codes.
  • Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
  • Verified final claim submissions by comparing account charges with documentation.
  • Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
  • Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
  • Communicated with healthcare personnel, including practitioners to promote accuracy.
  • Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
  • Sought clarification from physicians and other hospital personnel for answers to any needed coding interpretations prior to abstracting records.
  • Trained all front office staff
Education and Training
Associate of Science: Medical Insurance Billing, Expected in
Lincoln School Of Commerce - Lincoln,
GPA:
Accomplishments

Received excellent marks on yearly reviews and consistent bonuses

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Resume Overview

School Attended

  • Lincoln School Of Commerce

Job Titles Held:

  • Provider Executive
  • Medical Billing Manager
  • Revenue Cycle Manager
  • Coder

Degrees

  • Associate of Science

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