High-performing Manager with 17 years of healthcare experience in home infusion, revenue cycle management, insurance claims, contract management, provider relations, and medical office environments.
Skills
Intravenous therapy and specialty pharmacy comprehension
Consistently meet goals
Customer service-oriented
Exceptional interpersonal communication
Accounts receivable specialist
Expertise in invoice and payment transactions
Account reconciliation
Workers' compensation knowledge
Revenue Cycle Managment
Sales and Marketing Experience
Excellent communication skills
Enthusiastic yet professional demeanor
Savvy contract negotiator
CMS-1500 billing forms
Attention to detail
Physician billing
Team building
Intravenous therapy and specialty pharmacy comprehension
Consistently meet goals
Customer service-oriented
Exceptional interpersonal communication
Accounts receivable specialist
Expertise in invoice and payment transactions
Account reconciliation
Workers' compensation knowledge
Revenue Cycle Management
Sales and Marketing Experience
Excellent communication skills
Enthusiastic yet professional demeanor
Savvy contract negotiator
CMS-1500 billing forms
Attention to detail
Physician billingTeam building
Problem resolution ability
Healthcare billing proficiency
Experience
Sr. Provider Relations Representative, 02/2014 - Current Ascena Retail Group – Byron Center, MI,
Work with regional hospital administration and
practitioners to achieve effective working relationships and participating
physician satisfaction by developing relationships of trust and demonstrating
sound business decisions.
Establish and maintain effective business
relationships with providers and their offices. Act as a liaison between provider’s
offices, the provider network, and the organization to help build and
maintain effective relationships.
Resource to provide and / or direct offices to
information on policies, procedures, services, and programs.
Ensures
maintenance of open lines of communication to anticipate and resolve
issues, gathers information for policy steering, and communicates any
changes to offices.
Provide strategic input and recommendations at
regional level on decisions that affect physicians.
Work with all levels of management to sustain an
integrated relationship with a region.
Develop and standardize reporting for Provider
Development department in Symphony RM software to track progress of
initiatives and department goals for leadership and team.
Work closely with hospital case managers and physician offices to coordinate and schedule home IV patients through our practice ensuring continuity of care.
Verify patient insurance benefits and obtain authorization for all IV infusion patients.
Market practices IV services to providers and hospitals.
Review, initiate, and negotiate provider contracts with insurance companies to ensure fair pricing for services.
Update and submit provider credentialing applications to insurance companies and preferred provider organizations as needed.
Provide back-up assistance to billing, accounts receivables, and cash posting as needed.
Provider Network Contracting and Credentialing Manager, 01/2012 - 11/2012 Phelps County Regional Medical Center – Rolla, MO,
Initiate, prepare, and deliver participating provider agreements and credentialing paperwork.
Develop and maintain BrightPath client's relationships with physicians, payers, employers, and other health care professionals.
Develop, recommend, and implement best practices, policies, and procedures approved by the Executive Director.
Support and implement projects and strategic goals of the network established by Executive Director and Board of Directors.
Interface with a defined payers to execute on project requirements.
Work closely with the fee schedule messenger regarding fee schedules for existing and new contracts.
Provide support and assistance to the team as needed.
Created and verified HSD tables to
bring on new Medicare Advantage product to Idaho
Update Provider information to
database for provider contracts.
Prepare and deliver participating provider
agreements and ensure the contracts are executed.
Interface with a defined payers to execute on
project requirements.
Manager, 05/2002 - 11/2011 Critical Care System – City, STATE,
Manages the development, implementation, tracking of incoming referrals for 5 states (Idaho, Utah, Nevada, Arizona, and California).
Provide management direction and supervision of employees in clearance department including supervision/leadership, objectives/goal-setting, expediting problem resolution, and motivating department.
Develops implements and monitors policies, procedures and programs to ensure effectiveness of Clearance activities.
Updates and revises policies and procedures.
Designs and implements processes and reports to provide clearance information intra-and interdepartmentally.
Ensures continuous communication of the clearance department with payers, patients, and division staff.
Work closely with reimbursement contract management to create and negotiate contracts with health insurance payer's specific drug therapy to assure maximum reimbursement of goods and services.
Work closely with Business Development to design and implement comprehensive programs to support the introduction of new drug and therapies.
Work with Business Development/Marketing to support key vendor relationships, identify product/therapy issues, and recommend resolution.
Work in conjunction with training department to provide new and ongoing training programs for revenue cycle management team to ensure consistent understanding and execution of policies, procedures, and improving skills and performance of supervisor staff.
Review activities on monthly revenue report and profit, net, and loss reports to find trends, loss in cost of goods, or inaccuracies in billing or pharmacy input.
Partner with the general office manager to review monthly revenue reports to check for billing errors and high cost of goods.
Note trends of therapies that are not profitable and work with payers and corporate contracting department to negotiate better rates.
Claims Processor, 08/2000 - 05/2002 Blue Cross Of Idaho – City, STATE,
Processed medical claims and ensure proper payment in accordance with the benefit plan for national accounts.
Adjudication Supervisor, 05/1999 - 08/2000 IEC/Ameriben – City, STATE,
Trained and supervised claims adjudication team to input claims accurately in the claims processing system.
Supervised mailroom staff and claims network re-pricing team to also ensure accuracy and timeliness of work.
Loan Process/Title Clerk, 10/1994 - 01/2000 Key Bank – City, STATE,
Processed car titles to put Key Bank's lien on the titles.
Created training material for branch's to help get proper documentation when creating a loan to secure the banks lien.
Processed paid car titles and released Key Bank's lien.
Participated in mandatory team building training classes and workshops.
Cashier/Receptionist, 07/1994 - 10/1994 Target – City, STATE,
Answered multi-line phones and triaged calls to correct departments.
Provided assistance in departments throughout the store when needed.
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Education and Training
BBA: Business Administration, Expected in January 2014 - University of Phoenix - Meridian, ID GPA: Business Administration
Skills
Account reconciliation, accounts receivables, Accounts receivable, Attention to detail, auditing, back-up, benefits, billing, Business Development, CMS, interpersonal communication, Excellent communication, contract management, contracts, negotiate contracts, client, Customer service, database, direction, documentation, forms, general office, goal-setting, ICD10, insurance, Team building, leadership, Director, Managment, Market, Marketing, office, monitors, negotiator, Network, policies, pricing, problem resolution, processes, progress, reporting, Sales, sound, strategic, supervisor, supervision, Symphony, tables, phones, therapy, training material, training programs, workshops
Activities and Honors
Treasurer for Idaho HealthCare Conference Committee since 2014.
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School Attended
University of Phoenix
Job Titles Held:
Sr. Provider Relations Representative
IV Infusion Coordinator
Provider Network Contracting and Credentialing Manager
