Account Service Coordinator Resume Quincy, MA - Hire IT People

SUMMARY:

Diversified Healthcare professional with proven IT Analysis,, Operations Management and Process Improvement skills. Recognized as a subject matter expert in the area of Health Care Exchange (HIX) for the Affordable Care Act (ACA) as well as MassHealth Connector and New Hampshire Premium Assistance Program (NH PAP). Areas of expertise include:
Strong working knowledge of the 820, 835 & 834 EDI Healthcare files
Ability to lead, manage projects and develop policies and procedures
Ability to organize multiple projects and meet time deadlines
Knowledge of NCQA, JCAHO, HEDIS, CMS and NEQCA requirements

PROFESSIONAL EXPERIENCE:

Confidential, Quincy, MA

Account Service Coordinator

Responsibilities:

Gathered, analyzed, and interpreted EDI files
Managed unresolved and resolved cases/consumer issues that originated from the Health Insurance Marketplace Call Center and other sources.
Worked independently and directly with Federal & State agencies to resolve Exchange member issues
Trained colleagues on processes and system applications

Confidential, Quincy, MA

Credentialing Coordinator

Responsibilities:

Performed the review and analysis of the full array of information collected for the purpose of re - credentialing clinicians according to HPHC Credentialing Policies and Procedures
Assessed whether re-credentialing applicants meet the organizational criteria for approval by the HCHP Credentials Committee
Determined completeness, accuracy and consistency of the data collected

Confidential, Boston, MA

Ambulatory Clinic Supervisor

Responsibilities:

Lead the charge in the department achieving goals for Meaningful Use incentive payments, by providing real time hands-on of EMR
Oversaw 20+ clinicians and 10 administrative staff across four departments and acted as primary liaison between ENT department and all levels of staff throughout Confidential
Daily resolution of clinician billing issues via Patient Keeper, eCW, Sorian and RCO, resulting revenue recovery
Facilitated resolution of patient issues for administrative staff, resulting in full circle service recovery

Confidential

Operations Supervisor

Responsibilities:

Successful creation of mini call center to achieve targeted telephone call abandonment rate
Trained staff and faculty on use of EPIC patient portal (MyChart) and EPIC Charge Router
Resolved billing issues utilizing EPIC and Meditech
Accountable for compliance with budgeted and financial performance goals

Confidential

Managed Care Supervisor, BWH Patient Service Center

Responsibilities:

Managed daily operations of 60 person call center
Cross trained staff to endure adequate coverage for all practice areas, created workflow/process manuals specific to each practice areaDeveloped written, step-by-step workflow processes to ensure maximum performance

Developed, designed and delivered IDX technical, via classroom instruction, eLearning, lectures and role play
Lead trainer/project manager for several major MGPO IDX software initiatives
Delivered, provided implementation and “go-live” support to over 300 end users within a 4 month time frame
Developed IDX software UAT plans
Facilitated focus groups to understand needs of Professional Billing office

Confidential

Supervisor - Registration Dept., Professional Billing Office

Responsibilities: