In search of an employer with an innovative, client focused and rewarding work environment. Seeking work that will challenge me further while allowing me to contribute to the continued growth and success of an organization. Would enjoy a position that will provide me with the ability to apply my knowledge of the healthcare and insurance industry along with my management experience. More than 10 years of professional healthcare and Medicare regulatory experience. Exceptional oral and written communication skills. In depth knowledge of CMS Medicare Program Integrity Manual (PIM). Good understanding of health insurance processes. Excellent leadership, management and presentation abilities.
Education and Training
Bachelor of Science: Healthcare Management2014BELLEVUE UNIVERSITYBellevue, NEHealthcare Management
AS/ Diploma: Program2000IOWA WESTERN COMMUNITY COLLEGECouncil Bluffs, IAProgram
Supervisor, Medicare Part A Provider Enrollment01/2013 to 01/2016 Wisconsin Physician ServiceOmaha, NE
Serve as Subject Matter Expert for Medicare Part A enrollment regulation and processes.
Assist in the review of work instructions and department policies and processes.
Plan, organize and execute staff training on new or changed Medicare regulations and CMS technical direction letters as well as quarterly and annual staff training for quality assurance.
Resolve unusual or complex provider and supplier inquiries on Medicare enrollment process Serve as contact person for CMS initiated issues, assisting with and/or preparing responses to CMS's concerns relative to Provider Enrollment activities Provide leadership and guidance to Medicare Provider Enrollment staff with emphasis on quality assurance.
Ensure team is working to full potential and meeting all processing timeframes.
Responsible for tracking and analyzing staff production data using reporting tools and providing feedback to staff.
Participated in quarterly leadership and communication training for managers.
Responsible for hiring, disciplinary action, performance improvement plans FMLA, quarterly and yearly reviews with salary management and termination when appropriate Provide direction and guidance to healthcare providers, attorneys and consultants regarding Changes or Ownership, Acquisitions/Mergers and Consolidations.
Worked to maintain and build relationships with the provider community.
Interact with Medical staff, Administrators, State and CMS officials, Attorneys and interdepartmental personnel on a daily basis regarding Part A Medicare processes such as claims, audit, reimbursement and enrollment issues.
Analyst, Unit Coordinator, Medicare Part A Provider Enrollment01/2008 to 01/2013 Wisconsin Physician ServiceOmaha, NE
Serve as Subject Matter Expert Medicare Part A processes and regulations, assist with the creation and review of training materials and provide regulation and work process updates to staff as needed.
Perform secondary reviews and quality audits of work completed by Provider Enrollment Analysts.
Assist with testing of CMS software and WPS system updates.
Assist Supervisor and analysts with processing and the resolution of complex provider enrollment issues.
Work with the Zone Program Integrity Contractors (ZPIC) to identify and provide information on potential fraud cases.
Completed site visits to Medicare facilities to validate and verify compliance.
Interpret and educate analysts on CMS Program Integrity Manual (PIM) regarding Provider Enrollment processes and updates.
Approve, deny or return applications submitted by Medicare providers within the appropriate standards and timeliness established by Centers for Medicare and Medicaid Services (CMS).
Certified Medical Assistant/Clinical Lead01/2006 to 01/2008 Tolosa OB-GYN P.C. Council Bluffs, IA
Responsible for training and overseeing the daily activities of clinical staff.
Implemented and Organized CLIA, OSHA inspections and protocol manuals for the office.
Performed patient care services including, but not limited to, admission interview, accurate documentation and timely patient flow.
Prepared patient medical records and performed chart audits to ensure appropriate ICD-9 and CPT codes listed on the patient encounter form were accurate and that the chart met the required documentation for the level of the office visit.
Assisted healthcare providers with exams, treatments, procedures and testing as directed.
Performed phlebotomy and injections.
Scheduled and provided patient instruction for tests, treatments and hospital admissions, following correct insurance protocol.