Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Professional Summary
Highly motivated and successful professional of healthcare accounts receivables, with experience in both practice management as well as payer/provider relations. Extensive experience in managing multiple projects with competing priorities. Confident and experienced public speaker.
Education and Training
: , Expected in 1999 - Penn Valley Community College - Kansas City, MO GPA:
: , Expected in 1995 - University of Missouri - Columbia, MO GPA:
: , Expected in 1992 - Belton High School - Belton, MO GPA:
Skill Highlights
Independent
Tenacious
Goal Oriented
Self Disciplined
Sensible
Decisive
Professional Experience
Provider Relations Manager, 06/2010 - Current Modivcare – Melville, NY,
Accountable for full range of provider relations and service interaction within UnitedHealth Group, including working end-to-end claim resolution, ease of provider portal, training and development of external education programs.
Identify gaps in Network composition and services to assist Network contracting in prioritizing needs.
Design and implement programs to build and nurture positive relationships between the health plan, providers, and practice managers.
Supporting internal business partners to achieve shared goals within multiple product lines including Commercial, Medicare, Medicaid, and Tricare.
Accomplishments:
Improved provider satisfaction scores from 55% to 78%
Reduced the year over year aggregate service issue volume by 40%
Resolved 99% of issues within 20 days of receipt
Employee engagement vital signs scored 100% satisfaction, exceeding department and corporate averages
Awarded contracts to manage KS Medicaid effective 1/1/13 and Tricare effective 4/1/13; resulting in team expansion, extended provider scope support, and extensive communication and collaboration with business partners throughout the states of MO and KS.
State Business Manager, 2007 - 06/2010 Kansas City Cancer Center – City, STATE,
Recruit, hire, and manage business office staff of 19 individuals.
Monitored aged balances for approximately $23M, ensuring timely and efficient resolution.
Prepared monthly financial analysis on accounts receivables, collection percentages including extensive focus on payer & denial trends.
Created and implemented reimbursement policies and procedures, ensuring compliance with appropriate industry regulations
Accomplishments:
Decreased credit balances from $1Million to $100k
Decreased Days Sales Outstanding from 55 to 27 while increasing collections and reducing bad debt write off
Reduced staff by 50% while increasing efficiency
Reduced receivables over 120 days from 30% to 5%, exceeding company expectations by 50%
Created and implemented goal enriched environment and shifted receivable focus from 180 days to 60 days
Financial Services Unit, Accounts Receivable Supervisor, 05/2004 - 2007 Gentiva Health Services – City, STATE,
Supervise, mentor, and encourage staff of 8 by offering consistent and supportive feedback, assisting with goal setting while clearly defining expectations.
Responsible for timely and accurate billing and collections of approximately 3.5M for fourteen nursing branches in four states.
Developed positive relationships with business partners through extensive communication and collaboration
Accomplishments:
Due to new business in one month’s time, total accounts receivables portfolio increased by $1Million while receivables over 60 days declined from 30% to 20 %
Total credits kept to less than 5% of accounts receivables.
Maintained team accuracy of 99%
Awarded Gentiva's National “Gold” award for the individual in the company who best exemplified “TEA” (Timeliness, Efficiency, Accuracy)
CareCentrix Infusion Claims and Customer Service Supervisor, 03/2000 - 05/2004 Gentiva Health Services – City, STATE,
Supervised staff of 18 individuals in satellite claims processing/call center operation.
Maintained inventory control of claims; responsible for managing the adjudication of infusion claims.
Collaborated with Regional Care Centers to ensure proper creation of authorizations
Acomplishments:
Days claims outstanding maintained at 10 days or less
Awarded Gentiva's Customer Service Award in December 2001
Claims adjudication average of $12Million per month with 98% accuracy
Clinical Business Solutions, Account Representative, 08/1998 - 01/1999 Gentiva Health Services – City, STATE,
Coordinated national vaccination clinics with Delta Airlines and Cigna Healthcare
Network Accounts Receivable Representative, 04/1995 - 08/1998 Gentiva Health Services – City, STATE,
Researched patient accounts, verifying accuracy of adjustments and payment applications.
Affiliations
GKCMMA, Greater Kansas City Medical Manager Association
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School Attended
Penn Valley Community College
University of Missouri
Belton High School
Job Titles Held:
Provider Relations Manager
State Business Manager
Financial Services Unit, Accounts Receivable Supervisor
CareCentrix Infusion Claims and Customer Service Supervisor
Clinical Business Solutions, Account Representative
