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Project Manager Resume

TECHNICAL SKILLS

  • QNXT
  • Alchemy
  • Remedy
  • Propat
  • Shell Scripting
  • Agile Scrum Methodology
  • SQL
  • Emedon
  • Trizetto
  • Nebo
  • Availity
  • Primes
  • EHR/EMR Systems - Cerner
  • Epic
  • Zirmed
  • Meditech
  • Carelogic
  • Smart Care
  • ECW
  • EHR Implementation/Revenue Cycle Management
  • Provider education
  • Ambulatory/Physician/Hospital Billing
  • CMS/HFS
  • Medicaid
  • Managed Care/MCO
  • Medicare Insurance
  • Workman’s Compensation and self-pay
  • TPA
  • DASA/CHMC/FQHC
  • ANSI 835/ 837
  • Electronic authorization file 278
  • UBO4/ HCFA 1500/ICD10

PROFESSIONAL EXPERIENCE

Confidential

Project Manager

Responsibilities:

  • Executes strategic components of teh HCD business plan for each market.
  • Coordinates with segment constituents on medical cost and membership growth and network fortification initiatives.
  • Provider claims/billing education
  • Facilitating JOC meetings
  • Performing ADA/compliance visits
  • Assist with clinical audits as needed
  • Trouble shooting and problem-solving concerns
  • Participates in collaborative system and data design sessions with teh user community, technical architecture resources, and development resources
  • Contributes to teh review of Test Planning and Test Execution strategies
  • Current with DHS billing and compliance rules
  • Manage and build relationships with external stakeholders, providers and respond to customer service needs and concerns
  • Communicates with external constituents to TEMPeffectively engage teh provider community and demonstrate teh Aetna value proposition.
  • Proactively identifies new trends and products within Aetna and teh industry and works to raise awareness throughout teh organization in order to gain consensus on a course of action and ultimately drive to implementation.
  • Consistently monitors Aetna service capabilities to collaboratively ensure that provider constituent’s needs are met. Seeks to optimize provider interaction and provides recommendations based on balance of provider needs.
  • Responsible for developing and maintaining relationships with physician and business leadership of key physician groups, ancillary providers, and delivery systems.
  • Interacts with large, high profile groups and providers to facilitate solutions that are mutually beneficial for both providers and teh organization.
  • Collaborates cross-functionally on more complex issues to ensure provider needs are met and outstanding issues are resolved. i.e. provider service efficiencies, provider service improvement initiatives, identifies opportunities for process improvement.
  • Collaborates with internal team members on teh implementation of large, high profile physician groups, IPAs, PHOs and hospital systems to ensure a positive business relationship.

Confidential

Assistant Director

Responsibilities:

  • Responsible for maximizing teh collection of medical services payments and reimbursements from patients, insurance carriers, and state/private grants for 100 plus cite facilities
  • Annual Revenue of 50 Million
  • Collections and accounts receivable management, denial management, reporting and results analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight
  • Customer service relative to revenue cycle, training, analytics and all development and management relative to revenue cycle, analytics
  • Hired and trained staff and assisted
  • Managing daily productivity of staff,(12) revenue cycle training, credentialing, registration, claims management, billing, accounts receivable denial management, collections, patient insurance, patient account integrity
  • Implemented ZIRMED and oversaw all claims conversion and testing files
  • Claims configuration and testing
  • Develops SOP’s and training materials needed for billing, commercial billing and finance departments
  • Assisted in creation, orchestrated operation and negotiated contracts for commercial billing cite
  • Develops business workflow diagrams
  • Performs analysis and translates business needs to create high-quality Business Requirements and Functional Specifications documentation within specified time frames to solve moderately complex problems (multiple interfaces with other systems within a business unit) considering all impacted components from an end-to-end perspective.
  • Conducts impact analysis of technology changes on business processes and existing technology
  • Creates teh appropriate User-Interface Model(s) to support projects
  • Documents, tracks, and resolves issues related to data quality
  • Utilized BI (Business Intelligence) tools to aid in department growth and strategies
  • Analyzed loops and segments to ensure clean claim processing
  • Resolves escalated reimbursement issues with payers, practice and systems for optimal management of accounts receivable
  • Assisted C-suite with various revenue projects and analytics
  • Auditing monthly revenue and lockbox activity between company corporate, and healthcare accounts for month end close
  • Responsible for teh day to day supervision of billing and collections staff. Participated in teh hiring sequence of teh agency, and make recommendations on teh hiring or termination of team staff.
  • Responsible for provider reimbursement programs, policies and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment
  • Develops monitors and assesses business metrics in order to refine processes and improve efficiencies.
  • Establish internal goals and identifies external benchmarks

Confidential

Supervisor Billing & Collections

Responsibilities:

  • Maintained cite AR below one percent
  • Analyzed accounts for optimal insurance payment, submitted coding suggestions weekly
  • Assisted patients with HMO/Medicaid plans
  • Collaborated with coding and management team weekly
  • Analyzed claim utilization and medical cost data
  • Conducted monthly team meetings, and weekly meetings with staff
  • Managing daily productivity of staff, revenue cycle training, claims management
  • Created weekly goals and assignments for staff
  • Assisted case workers and nurses with access to additional resources for HIV patients
  • Trained all staff as needed, and assisted with interdepartmental cross training
  • Processed escalated claims
  • Researched accounts for billing/rejection trends
  • Completed monthly cite audits and claim edit errors and denial reports
  • Collaborated with IS department on billing and system issues
  • Generated refunds/appeals, verified referrals
  • Contacted insurance daily
  • Collaborated with coding and management team weekly

Confidential

Project Manager

Responsibilities:

  • Developed flow charts to reflect procedures and processes
  • Ensures that project team members complete tasks and deliverables on time and within budget, and that teh project delivers promised business functionality.
  • Trained new/existing staff on new systems and procedure changes
  • Lead, created assignments, supervised analysts on daily tasks and projects
  • Compared billing requirements to system capabilities and recommend system changes
  • Responsible for leading, planning and managing a project team with limited, local scope or sub-components of a larger project to accomplish project objectives.
  • Leads a matrixed team in executing assigned tasks and coordinating teh efforts of internal project team members
  • Manages to teh project budget, and reports project cost information in an accurate and timely manner.
  • Proactively evaluates project activities, builds contingency plans, executes corrective action, and monitors issue resolution to mitigate risks such as scope and/or budget variances
  • Updates teh Resource Management Tool upon project completion to document teh experience gained and skill set developed for project team members.
  • Informed Medicaid/Medicare patients about insurance options and county services
  • Assisted nursing and billing staff with HIV patient accounts
  • Participated in case management duties with DCHD homeless and mentally ill population
  • Participated in meetings with DHS
  • Provided patients access to emergency services provided by DCHD
  • Coordinated patient health insurance plans
  • Collaborated with clinicians and nursing staff regarding care management plans
  • Analyzed external billing changes to insure internal compliance,
  • Maintained payer order, payment cycles, resolves complex billing errors
  • Audits billing rejections, resubmissions, insurance verification
  • Maintained billing and collection projects as needed
  • Developed and supervised county self-pay system
  • Participated in supervising daily front and back office procedures

Confidential

Practice Manager

Responsibilities:

  • Documents, tracks, and resolves issues related to data quality
  • Implemented Thera Manager, increased revenue by 65%
  • Performs analysis and translates business needs to create high-quality Business Requirements and Functional Specifications documentation within specified time frames to solve moderately complex problems
  • Ensures end-to-end traceability of requirements is complete
  • Develops business workflow diagrams
  • Inbound/outbound insurance, patient, and tenant calls
  • Daily patient registration, scheduling, insurance verification, collected co-pays, referrals
  • Completes project activities on time and within budget, and proactively identifies and communicates issues that may jeopardize milestones or project budget to teh Project Manager
  • Conducts interviews, fact-finding, and independent research to design creative, progressive IT solutions for business problems
  • Hired, trained, created assignments and managed staff accordingly
  • Organized Bi-weekly and monthly staff meetings
  • Accounts payable/receivable, payroll, preparing bank deposits for various accounts.
  • Patient collections, insurance denial follow up, refunds/credits, resubmissions, AR/AP
  • Update and maintain doctor’s professional and hospital contracts, and HIPPA compliance

Confidential

Self-pay Collections Representative

Responsibilities:

  • Inbound/outbound insurance calls, all payer insurance follow up
  • Processing insurance refunds, credits, denials, resubmissions, Medicaid, Medicare, Commercial/Private
  • Daily insurance audits of foundation accounts
  • City of Chicago Crime Victim accounts, daily work files
  • Analyzed financial assistance applications

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