China Shaw

** ****** ******

973-***-**** or 201-***-****

acrxrj@r.postjobfree.com

QUALIFICATIONS BRIEF:

Anthem Wellpoint Amerigroup 14 Wall Street NY 10005 July 2014 to Present Administrative Coordinator (Provider Relations)

Provide support for the field team regarding provider related issues. Work with data management department, tracking and assisting with the provider demographics prior to publication,

Work on special internal projects regarding providers, skilled nursing, hospitals, stand alone facilities and other service locations.

Retrieve all voice mails from all eleven field representatives including directors and supervisors included. Scanning and retrieval of all department documents for review Tracking of W9 request for the contracting and credentialing department Tacking and assembling all marketing materials for the field reps and special designated teams IPA and others.

Participate in various other internal projects under the direction of directors & supervisors. Verified all in coming documents for processing from the field team as requested. Assist with logistics and verification for special projects for contracting team. Initiated outreach calls and other clerical functions for special projects credentialing & contracting. Update providers to the CAQH database of the health plan for contracting. Research and input all PRPN numbers for providers in a delegated group. Track and maintain database for FIDA initiative.

Answer and maintain all data via spreadsheet for NYNM. Assist with tracking of appeals and settlements for finance office. Set up of meetings, classes conferences and other in house functions. Horizon Blue Cross Blue Shield 3 Penn Plaza Newark NJ.07003 June 2013 to February 2014 Support Analyst: Case Management (Provider Relations Medical Policy) Retrieved and reviewed all post operation procedures pending claims for physicians and facilities to determine payment.

Review EOB (Explanation of Benefits) to determine if all guidelines were met according to contractual arrangements.

Reviewed ICD 9 and other DME codes for determination of payments to members or providers. Reviewed medical records with Medical Director to determine if additional information is needed to finalize payment.

Provided heavy phone contact with office and hospital professional coders to assure accuracy. Conducted medical necessity review of pending claims to determine finalization. Responsible for data entry and correspondence to other teams outside of designated claims area Conducted filing of medical and archiving of personal information according to BCBS policies. Reviewed all systems to assure all pre certifications for other participating surgeons are on file. Requested all necessary documents from other insurances for COB, Workers Comp claim payment processing.

Submitted all departmental update for providers to PDM department for accuracy Finalized review and generate letters to members/physicians on pending claims. Authorized payments to be generated

Saint Claire Hospital 801 0strum Street Bethlehem PA 18015 December 2011 to June 2013 Executive Admin Support(Credentialing Coordinator) Contacted governing agencies to determine if all credentials are up to date Searched appropriate databases to obtain necessary information regarding applying physician Verified through licensing bureaus regarding applicants current participation with agency Contacted state databases to determine if any adverse action is pending Verified physicians/facilities participation as being current Verified education and commencement with all schools Verified CME (continual medical education) with participating educational institutions Conducted and reviewed under medical director’s supervision all applicants prior to credentialing meeting.

Reviewed all applications to be finalized

Mailed all correspondence to notify offices of acceptance/denial into the network at the facility Conducted heavy data entry and outbound calls to office managers and physicians to obtain all necessary documents to be presented at the credentialing meeting Tracked minutes of credentialing meetings and sent them to the Medical Director for approval Assisted Provider Relations with folders that were approved for loading of providers accepted into the healthcare network at the credentialing meeting.

Morristown ENT Associates LLC 95 Madison Ave Morristown NJ 10967 March 2009 to June 2011 Lead Medical Secretary (Otolaryngology)

Assisted physician with all patient needs on a daily basis. E mailed and called in all pharmacy related patient medications. Scheduled all appointments for in patient and out patient procedures and pending surgery. Maintained the office data base for all six physicians. Initiated pre certification for pending surgeries. Arranged for one to one meetings between providers for medical necessity authorizations. Managed all medical records for all patients under lead physicians. Managed all imaging and scans for all patients in a six physician office. Maintained balancing of payments for copays at the end of office hours. Assist patients with medical records and referrals to other physicians possibly involved with follow up care.

Handled all of doctors meetings and peer to peer review on said cases with other insurance companies and other physicians.

Handled all physician calls and screened according. Prep patients upon arrival in triage center.

Trained and acclimated new hires to office procedures and policies. Input and confirmed pending records of all potential patients. Handled all new patient inquiries regarding services and testing. Initiated and finalized all inpatient admissions to Morristown Memorial Hospital. Performed heavy administrative functions within the practice for other physicians Translated and communicated bilingual needs to physicians. Performed credentialing and re credentialing for my assigned physician Assisted in instrument sterilization for all providers. Prepared examination rooms for same day minor procedures. Responded to all insurance issues and precertification for a six provider office. Provided major support for all patient concerns under the providers directives, testing results etc. Executed payment posting of procedures and office visits. Assisted in training and development of all new hires and summer interns in the clerical admin role. Skills:

Knowledge of NASCO ERISCO NPDB AOA AMA STATE LICENSING MICROSOFT PEOPLE SOFT, CENTRTICITY,MD OFFICE,MD NAVIGATE,OUTLOOK, IGENIX, ALL SCRIPTS,COMPUTER PROFICENT VARIOUS OTHER SOFTWARE PACKAGES.AVAYA PHONE MERIDIAN, MEGAPHEONIX SCHEDULING PRO. FACETS, MYSIS WINDOWS 7, LOTUS NOTES, CITRIX ETC. CALL CENTER INBOUND AND OUTBOUND Extensive knowledge of central supply and long term care. Payment posting & collections Currently proud holder of The Hearts of Hospice Award 2011 2013 Patient Access Certified

Education: Sawyer School of Business Graduate class of 1982. Area of study Healthcare SCS School of Medical Arts Graduate certificate of completion June 1985 2 YEAR PROGRAM