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Project Manager Resume Profile

OBJECTIVE To obtain a position that will utilize my abilities and skills to increase productivity, efficiency, and reimbursements. Attributes: Detail oriented, multitasker, team player, organizer and planner, troubleshooter, positive attitude, excellent customer service skills, and strong work ethic.

EXPERIENCE

Confidential

  • Customer service representative/analyst process premium payments, follow and maintain current policies, process lapsed policies, spot negotiate providers' high dollar claims, assist in creating new SPD on spot negotiations, control incoming claims for processing, troubleshoot claim controlling issues, train staff, assist with adjustments, troubleshoot policyholder issues, assist in meeting monthly IBM and Prudential SLA goals

Confidential

  • Passed State Licensing Board annuities, life and health insurance

Confidential

  • Implemented EMR with Carolina Cardiology's GE system
  • Implemented new workflows with the GHS work systems and requirements
  • Manage medical records requests and audits
  • Manage financial and coding
  • Implemented tracking system for Medicare reimbursement issues for EP with success reduced denials by 85
  • Manage reimbursements, denials and appeals, coding streamline process, improve reimbursements
  • Manage CPT coding and ICD-9 updates
  • Train staff and monitor billing and coding, reimbursements, denials and appeals
  • Regular meetings with physicians on coding and ICD 9 issues including documentation, individual patient documentation review for appeals and reimbursement
  • Yearly updates and reviews with physicians on coding and ICD 9 changes

Confidential

  • Involved in UMG acquisition with leases, financials, audits, staff training, new workflows
  • Outpatient and Inpatient billing from 1996 forward process reimbursements, denials and appeals
  • Yearly updates and reviews with physicians on coding and ICD 9 changes
  • Regular meetings with physicians on coding and ICD 9 issues including documentation, individual patient documentation review for appeals and reimbursement
  • Train staff on billing and coding
  • Manage CPT coding and ICD-9 updates, billing for office and procedures
  • Grew practice from 1 physician to 4 physician practice
  • Manage reimbursements, denials and appeals, coding streamline process, improve reimbursements
  • Manage payroll, financials, banking paperwork, accounts payable, and account receivables, reconcile monthly basic statements, credit card statements
  • Work directly the accountant on PA financials and auditing
  • Manage up to 16 employees, 4 physicians, and physician extenders
  • Credentialing of physicians with insurance companies
  • Maintain licensing and CME requirements for physicians
  • Manage physician billing of 72M per year
  • Manage Human Resources , including hiring, firing, employee yearly evaluations, benefit package, training
  • Administer and train employees on the PSP Trust
  • Develop, implement and monitor business operation plans and systems
  • Oversee and evaluate need and purchase of equipment and materials
  • Establish cash management system
  • Maintain and evaluate insurance contracts
  • Develop and maintain systems for information flow throughout office for clinical and non-clinical staff
  • Administer the Misys billing system, internet, security
  • Manage and protect patient records implement HIPPA and manage and maintain HIPPA requirements
  • Manage and oversee audits
  • Manage physician schedules and patient flow
  • Manage and oversee collection process
  • Oversee physician credentialing, licensing
  • Managed and oversaw expansion, construction and remodeling of building in 2001
  • Manage building and grounds

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