SUMMARY:

• To obtain a position within a health care setting in which I can utilize my healthcare administration experience and trained customer service background that will strengthen the reputation of an organization, and contribute to the overall performance.
• Experience in healthcare administration/Business Processes while working as an Outpatient Assistant, Pre - Authorization assistant, Grant Closeout Specialist, and Jr. Business Analyst. Works independently and exceeds expectations.
• Able to multi-task, prioritize, and meet crucial deadlines without compromising quality

TECHNICAL SKILLS:

Office Skills: HMO Managed Care, Records Management, Electronic Filing, Spreadsheets/Reports, Project team member, Reporting/Health Care Environment, QHP Project Coordination, Customer Service, Business Process/Processes, CAPM Training

Computer Skills: MS WordMS ExcelMS PowerPointMS OutlookMS AccessImpac IIERA CommonsGrants Closeout ModuleITILOracleRemedyJira

PROFESSIONAL EXPERIENCE:

Confidential, Rockville, MD

Customer Service Representative

Responsibilities:

• Provide Tier 2 telephone and email customer service support using a supplied helpdesk
• Triage and document incoming inquiries
• Identify the proper channel to resolve customer issues and follow up on resolutions
• Review, understand, and apply knowledge of federal rules to provide accurate responses to inquiries
• Provide accurate documentation and update all required systems on each customer issue
• Draft responses to complex email inquiries and obtain approval from CMS staff Respond to email inquiries using standardized and approved language and scripts, frequently asked questions, or program information available on the CMMI web site within federal rules
• Assist with the development and revision of program frequently asked questions
• Log and track open inquiries to closure using an internal tracking system
• Report on inquiries from stakeholders, including call volume, peaks, and spikes
• Monitor the status of inquiry responses
• Assist with the development and maintenance of a collection of email contact list by various metrics
• Store and maintain documents and deliverables for spelling, grammar, and consistency
• Perform other duties as directed

Informal Review Analyst Tier II

Responsibilities:

• Review Informal review requests submitted by PQRS eligible professionals for completeness and validity in Remedy and IRMA systems within Tier 2 PQPMI department
• Perform research and analysis for appropriate resolution utilizing processing finder files such as ACO, GPRO, QRDA, and CPC. Accessed Feedback Report, and AIA system within CMS portal.
• Process the request, develop and disseminate the correspondence and validate information with the appropriate tools, escalated to Tier 3 if needed
• Track and update the Informal review log daily
• Provide metrics and stats daily/weekly
• Active contributor on conference calls

Jr. Business Analyst

Responsibilities:

• Exercised discretion and independent judgment involving the comparison and the evaluation of possible courses of conduct
• Acted and made decisions independently after considering various scenarios and possibilities
• Performed tasks that affect business operations to a substantial degree
• Participated in planning long or short-term business objectives
• Collected, documented, and analyzed information concerning clients’ current financial or business processes and information systems.
• Identified and documented deficiencies and dysfunctions in existing financial or business processes and information systems
• Responsible for coordinating regular meetings with the full operations team and facilitating resolution of identified cross-area issues
• Issued management (intake, validation, documentation, monitoring to resolution, responding to inquiries); requires the ability to learn to use an issue management software program
• Responsible for alerting the MOCC to any 2016 open enrollment related issues as soon as they are identified
• Provided information and updates to the Open Enrollment team regarding any topics impacting operations for 2016 open enrollment
• Frequently reached out to and coordinate with business operations leads
• Partnered with MOCC to develop issue resolution action plans
• Documented of open enrollment activities
• Overall MOCC program processed improvements

Group Database Assistant

Responsibilities:

• Worked in the Benefits Administration department. Renewed contracts for small groups, individuals, and family
• Corresponded with departments such as Underwriting, Account Management, and Sales in regards to any discrepancies on contracts for new and renewed contracts. Renewed fifty contracts daily for large and small groups
• Verified the accuracy of information on source documents
• Entered demographic and rate data information into system database for new and renewing group contracts and individual products
• Entered revisions to group and individual products as outlined in the contract
• Ensured the readiness of billing batches before the monthly billing cycle begins
• Prepared the batching of documents for Macess EXP as required
• Performed the data input for monthly termination of groups based upon request received
• Performed group transfers upon request
• Interacted with internal staff and external customers

Grants Management Closeout Specialist

Responsibilities:

• Worked in the Central Operations/Grants Closeout department for the NCI Institute assisting with backlog.
• Gathered and uploaded all necessary documents such as the Final Invention Statement, Final Report, and Inclusion Enrollment Report for closeout.
• Corresponded with Principal Investigators and Business Officials to request documents that were not received. Implemented strategies to expedite closeout process. Worked on approximately eighty grants daily.
• Processed Training, Research, and Fellowship Grant forms.
• Routinely ran and monitored institute discrepancy reports for accuracy and completeness.
• Properly managed electronic files including creating, managing, closing out, disposing, and transferring files following the IC’s protocol.
• Filed all related documents for unfunded grant applications within one day of receipt or as directed by the IC into electronic folder
• Reviewed grant details to ensure the file can be closed
• Sent letters to grantees concerning required submittal of closeout documents

Surgical Scheduling Assistant

Responsibilities:

• Worked as a Surgical Scheduling/pre-certification assistant for a private practice that consisted of seven doctors.
• Scheduled and pre-certified procedures and surgery daily.
• Interpreted progress notes dictated by doctors to nurse case manager at insurance companies to ensure all denials were approved. Pre-authorized fifteen surgeries daily
• Verified benefits/eligibility and pre-certified operating procedures (inpatient and outpatient) with insurance company; translated doctor’s dictated notes in patient’s chart to nurse case manager at insurance company; Informed Surgical Scheduling Manager of any denials/problems with admissions.
• Coordinated pre-op testing with primary care physician or hospital; assured consultant treatment plans are signed by PCP and given to billing department.
• Provided guidance to therapist such as Acupuncturist, Physical Therapist, and Chiropractor on proper documentation needed to pre-authorize patients for surgery.
• Pre-certified all inpatient and outpatient procedures (MRI’s, CTscans, X-rays, etc.) as required by insurance companies.