Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Professional Summary
Highly accomplished medical professional with a diverse background in medical staff management, medical and business office management/administration, and insurance authorization. Proven problem-solving, analytical, and creative thinking skills in a complex environment.
Skills
Type 50+ WPM
Electric Medical Records
20+ years working in healthcare which includes 6 in Oncology
Project management
Analytical thinker
Quality improvement competency
Work History
02/2014 to CurrentProvider Network Manager Anthem, Inc. | Russellville, AR,
Responsible for provider contracting and maintaining positive working relationships with all participating providers and payers.
Serve as a liaison between the provider, payer and NCH's internal departments to address and resolve issues.Â
Responsible for conducting provider in-services and educating network providers and supporting office staff on the process and policies of NCH. Provide ongoing support to the staff and providers.Â
Meet with groups quarterly either in person or virtually to go over the data and discuss any needs from the group. Â Â
Constant communication with payer representatives and help with member transitioning.Â
Help implement new markets by working with payers in targeting groups, reaching out to the providers, setting up provider meetings and conducting training to the staff.
04/2012 to 01/2013Prior Authorization LeadHackensack University Medical Center | Belle Mead, NJ,
Oversaw the chemotherapy authorization department  and obtain prior authorizations.Â
Managed and trained the staff. Â
Supported the Claims and Denials departments to ensure all authorizations were obtained and no claim denials for "no auth". Â
11/2011 to 03/2012Prior Authorization SupervisorNevada Cancer Center | City, STATE,
Obtained prior authorizations for chemotherapy services.Â
Worked with various insurance companies to verify and obtain authorizations on a daily basis. Â
07/2010 to CurrentSpecialist, Prior Authorization/ SupervisorNEVADA CANCER INSTITUTE | City, STATE,
Worked collaboratively with clinical areas to ensure prompt prior authorization and insurance/benefit verification for oncology-specific services, procedures and treatments.
Specialized in obtaining STAT authorizations.
Developed key relationships internally and externally with insurance agents to ensure fast turn-around times.
Back up front desk personnel.
All aspects of Medical Records.
Audit prior authorizations for department personnel.
07/2008 to 2010Residency CoordinatorUNIVERSITY OF NEVADA SCHOOL OF MEDICINE | City, STATE,
Ensured
appropriate orientation and education to 3rd and 4th year
residents, and maintained daily operates within department.
Set up appropriately
lectures and schedules.
Maintained department operational functions,
including assisting where necessary, managing calendars, and maintenance of
faculty credentialing files.
Education
Expected in 1995Diploma | Medical Office ManagementSAWYER BUSINESS COLLEGE, SACRAMENTO, CAGPA:
Coursework in Healthcare Administration
Coursework in Health Services Administration and Business
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