Senior Health Plan Representative resume example with 20+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Summary
Enthusiastic Healthcare Professional seeking an administrative or operational position that supports leadership in their organizational efforts to provide successful and sustainable patient care.
Skills
Healthcare operations
Health plan coverage & benefits
Healthcare management
Quality & regulatory auditing
Goal planning & team building
Defining & coordinating project plans
Coordination of training & development
Safety and health standards
Forecasting and scheduling
Health inspection preparation
Experienced in healthcare systems: EPIC and Foundations Healthcare Systems
Experienced in Microsoft Office Applications and Google Applications
Experience
10/2018 to Current
Senior Health Plan RepresentativeWilson Memorial Hospital – Sidney, OH,
Assist the Health Plan Operations Director with complex projects pertaining to health plan regulations in collaboration with healthcare administrators in both inpatient and outpatient settings
Support physician reviewers with second opinion pre-grievance referrals adhering to regulatory guidelines set be the Department of Managed Healthcare (DMHC), Centers for Medicare and Medi-Cal (CMS), and Joint Commission on Accreditation of Healthcare Organizations (JACHO)
Supervise daily functions of Health Plan Representatives for the Marin/Sonoma Service Area by reviewing grievance and inquiry case documentation and providing training on current regulatory guidelines
Perform monthly internal audits of Health Plan Representative inquiry cases that pertain to healthcare services and health plan coverage benefits
Unit Based Team Co-lead supporting the Member Services Department by facilitating monthly meetings, creating team agendas, creating project mapping tools, compiling data and taking detailed meeting minutes per the Regional Labor and Management Agreement and expectations (SEIU-UHW)
Prepare and present formal presentations given to all departments within Kaiser Permanente focusing on Member Services Department functions and workflows
03/2000 to Current
Clinical Medical AssistantMettler Toledo – Columbia, NC,
Provided clinical and administrative support to sub-specialty physician chiefs and their colleagues (Infectious Diseases, Oncology, Nephrology, Cardiology, Pulmonology, and Chemo Infusion Center)
Processed referrals
Managed clinic schedules and physician hospital on-call schedules
Coordinated patient scheduling for multiple sub-specialties in collaboration with diagnostic imaging and laboratory departments, Home Health, and Skilled Nursing Facilities
Coordinated outpatient PICC line placements with the Kaiser Satellite Infusion Center for the Infectious Diseases Department while working 10 years in the Infectious Diseases Department
Coordinated presentations, meetings, and Tuberculosis, Zika Testing, HIV/STD, PrEP Clinics with the California Department of Public Health and the Sonoma County Department of Public Health while working 10 years in the Infectious Diseases Department
Tracked and managed inventory for exam rooms, maintained vaccine and expiration logs, created Excel tracking spreadsheets for various patient populations
Promoted continuity of care by accurately and completely communicating patient status to fellow caregivers
Assisted physicians with minor surgical sterile procedures
Performed patient vital signs, wound care, and vaccinations documented in EPIC
Software experience: EPIC, Foundations Healthcare Systems, Microsoft Office Applications, and Google Applications
05/1994 to 01/2000
Production AssistantNew Zealand Milk Products – City, STATE,
Prepared US and Canadian Customs documentation for the import of milk and whey proteins from New Zealand
Coordinated logistics (container and truck load arrangements) for foreign and domestic clients
Supported three Production Managers with the forecasting of large volumes of milk and whey protein manufacturing for sale in the US and Canada
Assisted Canadian Sales Representative by arranging production contracts for Abbott Laboratories and Bristol-Myers Squibb
Processed foreign and domestic contracts and purchase orders
Elected by NZMP Leadership Team to become ISO 9000 Certified as Internal Quality Auditor for all business operations
Education and Training
Expected in 05/2018
Bachelor of Arts: Business Administration And Management Dominican University of California - San Rafael, CA GPA:
Expected in 06/1984
High School Diploma: Immaculate Conception Academy - San Francisco, CA, GPA:
Additional Information
Dominican University of California, San Rafael, CA
Presented: International Honors Society in Business, Management, and Administration
Presented: Honors Society for Adult Learners in Continuing Higher Education
Certifications
Certifications:
Boston Reed, Santa Rosa, CA
Clinical Medical Assistant Certification
February 2000
International Quality Management and Systems Standards Certification Program
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