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Sr. Reimbursement Counselor / Site Coordinator Resume

Fort Mill, SC

SUMMARY:

Dedicated, innovative, project focused, resourceful, and career driven individual who excels in providing creative, quality, and effective marketing communication strategy.

CORE STRENGTHS:

  • Excellent collaborative abilities with new and established with vendors/clients
  • Well - organized and effective trainer/SME/supervisor 15 + employees
  • Excellent verbal and written communication skills
  • Community Relations Liaison
  • Instructional Design and delivering training in various learning environments
  • Documenting and implementing business processes, work-flows, SOP’s, and requirements
  • Intermediate Proficiency in MS Outlook, Word, Excel, Access, Visio, and PowerPoint
  • Business consulting (Multimedia platforms, websites, marketing plan, and more)
  • Strong Excel background (V look up, Reporting, Pivot tables, Macro creation, etc.)
  • High profile project management experience with local government
  • 10 Years of Adobe Creative Suite Experience (InDesign, Captivate, Photoshop)
  • Event Management and Coordination of small to large events within the community
  • Lean Six Sigma (5s, Kaizen) /Process Improvement
  • Solid analysis of results and fine-tuning of developed processes

PROFESSIONAL EXPERIENCE:

Sr. Reimbursement Counselor / Site Coordinator

Confidential, Fort Mill, SC

Responsibilities:

  • Pharmaceutical account management and liaison between the company and contracted healthcare facilities
  • Implementing training for assigned region including but to limited to online, face to face, and/or conference call delivery.
  • Trained new employees, sales team, clients, and/or staff on policy, procedures, updates, and best practices
  • Created SOP’s for the drug cycle specifically for the region
  • Design templates to track quality, work load, and case analysis
  • Maintain compliance of the Confidential REMS process for new and existing providers and facilities
  • Assist in the claims process for insurance billing (private, Medicaid, Medicare)
  • Coordinate the shipping of MS medication, address ongoing service needs, etc.
  • Verify benefits and coordination foundation or copay assistance programs as needed.
  • Create and maintain reports for area, regional, and district managers regarding territory.
  • Suggested an employee mentor program and worked with upper management on how to execute the program.

Temp Business Analyst/Trainer

Confidential, Charlotte, NC

Responsibilities:

  • Communicated frequently with the project team regarding the applications functionality requirements, County needs, areas for improvement, and possible modifications for ease of use.
  • Conducted and participated in user acceptance testing to ensure the new system (Govern) satisfies the needs of the County and its over 1 million taxpayers and businesses
  • Technology/process support / UAT for the new Govern Business Tax system for Confidential County.
  • Worked crossed all business tax departments including Accounting/Finance, Compliance to ensure that the accounts payable and receivables and reporting reflected the business tax laws and rules per County and State guidelines.
  • Moderate to heavy Excel use such as Confidential up, macro creation
  • Uploaded walkthroughs, UAT pass/fail results and other project information to SharePoint.
  • Being brought into a project that had already been started over a year ago, I quickly learned the system and trained other full-time employees, provided feedback on the ease of use, and more.
  • Co Authored Tax Manual for County Tax system and tax finance break down guide for cities and municipalities.
  • Met all project timelines and deadlines as outlined such as case/account audits.
  • Worked closely with upper management, senior analyst, and product vendor to execute final system product launch.
  • Designing development plans/coaching
  • Prioritized work requests from project team
  • Design & presented the training document for the new system that included new processes and improved SOP’s.
  • Conducted development and/or process workshops/presentations on topics such as metrics, promotions, recruitment, transfers, on boarding, off boarding.

Lead Provider Installation Specialist/Clinical Administrative Coordinator

Confidential

Responsibilities:

  • Program Management/Process Improvement
  • Supervised over 10 Confidential ’s and 15 + RN’s for pilot program
  • Drive the Performance Management process while ensuring evaluations are administered in a fair and effective manner.
  • Moderate to heavy Excel use such as pivot table, Confidential up, macro creation
  • Contact facilities verifying patients’ current admission status, verifying insurance, and/or COB
  • Maintain patient cases and providing updates to the assigned nurses for case follow up
  • Installation and updating new/existing provider contracts, fee schedules, demographics, and more
  • Supporting providers by updating procedure authorizations and bed dates to reduce case turnover times
  • Running daily patient reports for special projects, team workload management, and supervisor reporting.
  • Special products and scheduling project manager for AARP MyCarePath Program
  • Team Level Subject Matter Expert in Microsoft Office applications support
  • Coordinating Department level yearly employee survey results and working with upper management to resolve or acknowledge areas for improvement.
  • Claims processing
  • Creating and updating Share Points, SOP’s, and daily reporting via Excel spreadsheets.
  • Drafted meeting agendas, supplied advance materials, and executed follow-up for meetings
  • Internal System Knowledge: Phyon, NDB, HSR (IQUE), Emptoris, FACETS, COSMOS

Lead Healthcare Billing Specialist

Confidential, Greensboro, NC

Responsibilities:

  • Supervised over 10 Confidential ’s and completed program audits for quality
  • Medical laboratory company with thousands of locations and provides extensive laboratory services
  • Processed 3rd party accounts receivables and payables
  • Prepare claims for insurance billing (private, Medicaid, Medicare)
  • Reconcile insurance claim denials in a production environment
  • Researched and verified correct billing information and contacted providers for missing account information.
  • Complete basic level ICD9 coding course and translated medical verbiage
  • Suggested an employee mentor program and worked with upper management on how to execute the program.
  • Moderate to heavy Excel use such as pivot table, Confidential up, macro creation

Lead Claims Analyst and Executive Sales Administrative Assistant

Confidential, Greensboro, NC

Responsibilities:

  • Major carpet manufacturing company with brands such as Broadloom and Karastan
  • Accounts receivables and payables for claims, sub-contractors, vendors, etc.
  • Prepare claims for carpet defects, customer dissatisfaction, and other discrepancies
  • Reconcile claims
  • Handled five territories in six states with four sales VP's and their sales teams.
  • Coordinated meetings, sales packets, and various clerical duties for each territory such as balancing sales project
  • Expenses, creating and processing purchase orders, and reconciling accounts.
  • Drafted meeting agendas, supplied advance materials and executed follow-up for meetings and team conferences.
  • Planned travel arrangements for 2 teams of senior sales account managers. (6 people total)

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