To obtain a position within a company that would utilize my skills and experiences and allow professional and personal growth. Experienced Provider Relations Manager with a demonstrated history of working in the health care industry for over ten years. Skilled in Physician and Payor Relations, Quality Improvement, Health Insurance, Marketing, Contracting, Health Care Management and Administration. Strong healthcare service professional with a Diploma focused in Medical Billing and Coding from Florida Technical College and currently working on my Bachelors Degree in HealthCare Management.
Skills
Over eleven years of experience in Management, Customer Service and Healthcare
Call Center Operations
Proficient in Medicaid/Medicare Management Information Systems
Work well under pressure
Strong presentation skills
Capable of strategic planning
HEDIS knowledge-Quality improvement competency
Planning & Strategic Planning
Claims analysis and review specialist
Healthcare Billing and Medical Coding ICD-10 and CPT/Healthcare Billing Proficiency
In-depth claim knowledge
Knowledge of risk adjustment factor
Contract negotiations
Bilingual (English/Spanish)
Critical thinking proficiency
Strong Clinical Judgement
Excellent multitasking
Personal and Professional integrity
Team Player
Type 60 WPM
Evoke 360 Portal
E-clinicals EMR
Athena EMR
KAREO EMR
Availity Portal
Experience
06/2021 to 01/2022
Value Base Care ManagerDATALINK FUND SOLUTIONS – City, STATE,
· Communicate with provider groups on the benefits of Value Base Care and how to increase their Quality and Risk scores using Evoke 360.
· Increase user engagement across all provider groups to improve clinical and financial outcome.
· Lead Value Based Care strategies to increase quality metrics for the Medicaid or Medicare line of business.
· Monitor and manage key deliverables of the physician office implementation and onboarding processes.
· Educate providers on products enhancements and new releases
11/2015 to 06/2021
Sr. Physician Business ManagerOPTUM PART OF UNITED HEALTH GROUP/WELLMED MEDICAL – City, STATE,
Confidently manage overall operation of patient care, or conditions, that might hinder patient's well-being including financial management, quality assurance, patient care, safety risk management, team satisfaction, quality scores, high utilization and facility maintenance.
Initiate audit process to evaluate thoroughness of documentation and maintenance of facility standards.
Maintain communication between department heads, and medical staff by attending bi-weekly and quarterly financial meetings.
Implement continuous quality improvement guidelines to measure the performance of business operations.
Foster strong, positive relationships with all 25 providers and practice managers on the panel.
Made biweekly visits.
Oversee day to day operations including efficiently and accurately managing provider demographic information such as DEA and licensing renewals.
Assist in credential audits and on-site provider assessments.
Identify and remediate claims to ensure early resolution of claim problems.
Provider education of incentive programs and facilitation of member Healthcare records.
Assume lead for special projects by assisting with mail expansions and tracking spreadsheets.
01/2011 to 11/2015
Practice Manager/Biller/Medical CoderIGNACIO SALZMAN, MD – City, STATE,
Manage employees and delegate authority, responsibility to other staff personnel as deemed necessary to perform their assigned duties, counsel discipline personnel as deemed necessary.
Process daily encounters and charge sheets as well as posting payments and batching.
Maintain and oversee employee continuing education program.
Review and submit employee time sheets for all office personnel processed bi-weekly through Paychex.
Evaluate employee performance quarterly and recommended merit increases.
HEDIS training with doctors and medical staff.
Guarantee Medicare, Medicaid, and Insurance compliance regarding claim filing, coding, and medical documentation.
Responsible for office accounts payable and receivable.
Responsible for hiring, training, coaching, and counseling.
Established staff schedules and assignments based on office needs.
Responsible for implementing objectives, policies, and processes of medical Healthcare.
Achieved high staff morale and retention through effective communication, prompt problem resolution, efficient supervisory practices and facilitating a proactive work environment.
Collaborate with doctor to ensure proper maintenance of up-to-date medical certifications.
Motivated staff by offering direction and providing constructive feedback.
Created and implemented policies and procedures for effective practice management.
Communicated with patients with compassion while keeping medical information private.
Education and Training
Expected in 12/2022
Bachelor of Science: Healthcare Management RASMUSSEN UNIVERSITY - Tampa, FL, GPA:
Expected in 02/2011
Associate of Applied Science: Medical Billing/Coding Florida Technical College - Kissimmee, FL, GPA:
Medical Billing and Coding Diploma
Accomplishments
Promoted from Medical Biller/Coder to Practice Manager, in less than 12-months
Created highly effective new [Program] that significantly impacted efficiency and improved operations.
Consistently maintained high customer satisfaction ratings.
Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.