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Field Services Representative Resume Profile

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FL

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Professional Summary

Highly analytical professional in the area of health care management with more than 10 years of work as an innovative, customer-oriented professional with a strong background in quality assurance, claims analysis, and management principles and practices. Accustomed to the integration of new Medicaid Management Information Systems, and restructuring of work in an increasingly complex environment.
Skills

Independent judgment and decision making

Florida Medicaid Management Information Systems FMMIS proficiency

Exceptional communication skills

Attention to detail

FL Medicaid statues and regulation interpretation

Centers of Medicare and Medicaid Services CMS regulation interpretation
Work History Manager Confidential

Trained, coached, and mentored staff to ensure unit goals were accomplished and a smooth adoption of new policies and programs. Recruited, hired, trained, staff. Represented and interpreted the agency's functions and services to other institutions, the public, government agencies and other community organizations. Manage exceptional claims processing. Researched and resolved escalated claims issues through experience and knowledge of fiscal agent operations. Monitor all phases of the fiscal agent's operations, including the development and reporting of performance standards.

Program Analyst Develop Medicaid program policy, and determine Medicaid program rules for the implementation of new services and clinical trials.

Field Services Representative Confidential

Effectively serviced as primary liaison for HP and client, provider and public associations, lobbyists and partners. Reviewed customer survey information to prioritize areas of improvement. Routinely collaborated with department managers to correct problems and improve services. Trained providers and call center staff on billing and claim submissions. Directly participated in the fiscal agent transition and new FMMIS implementation to assist State staff, and providers of various service types.

Analyst - Confidential

Implemented user acceptance testing with a focus on documenting defects and executing test cases. Mapped process activities to desire outcomes to rectify operational inefficiencies. Recommended operational improvements based on tracking and analysis. Researched and provided resolution of claim billing and processing issues within the FL Medicaid Management Information System FMMIS . Utilized ICD-9 and CPT national standard references to interpret and communicate Medicaid claim processing. Completed timely responses to data request for claims and eligibility HIPAA standard inquiry transactions. Assisted customer with disputes related to delays with transaction responses. Developed leads, outreach, and promotions for online Medicaid Eligibility Verification System MEVS . Ability to understand and verbalize commonly used concepts, practices, and procedures related to Medicaid and MMIS.

Manager Confidential Owner Confidential Manager Confidential Claims Biller Confidential Claims Collections Confidential Front Office Coordinator - Confidential
Flagler College - TALLAHASSEE, FL

Bachelor of Arts in Business Administration

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