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Medicare Manager

United States
January 03, 2010
Contact Info:


*** ***********, ******, ********** ***** (310) ***-****


A significant contributor to highly successful companies. World-class leader, results oriented, positive and proactive, unparalleled work ethic, excellent focus and direction, in addition to, interpersonal and organizational skills. Adept at planning, executing, monitoring and reporting results. Displays strong loyalty to superiors and organization.




Government Applications and Credentialing Manager (November 2008 – Present)

Revenue Cycle Management Department

• Manages staff and workload of Government Applications and Credentialing Units

• Responsible for full review of due diligence documents for each acquisition

• Responsible for working with new entities for divesture of centers

• Reviews and monitors closely changes to Federal Register, Program Integrity Manual and Independent Diagnostic Testing Facility (IDTF) Standards to ensure appropriate changes are noted and communicated.

• Visits facilities to ensure all full compliance in accordance with federal and state government standards

• Facilitates National and Regional meetings with all Center Mangers and Directors, to communicate changes and raise management awareness of Government regulations and policies.

• Obtains documentation and information for multiple operational areas to attach and compile for enrollment and compliance purposes.

• Constantly reviews all technologists and physician roster to ensure enrollment sent to agencies timely.

• Review credentials and licenses of all radiologists and technologists before enrollment into the government programs

• Completes all government enrollment forms and applications, to include but is not limited to Medicare, Medicaid, TriCare and ChampVa.

• Review each State Medicaid Compliance Policy to ensure that state enrollments are in full compliance and continually adheres to state requirements.

• Responsible for maintenance of National Provider Identifier (NPI) of facilities through the National Plan and Provider Enumeration System (NPPES).



Provider Enrollment Coordinator (April 2008 – November 2008)

Legal Department

• Coordinates meetings with Regional and Operational Managers to discuss compliance start up sites.

• Review of documentation to ensure that facilities are in accordance with Social Security Act

• Responsible for maintenance all government files within the department

• Review credentials and licenses of all radiologists before enrollment into the government programs

• Completes all government enrollment forms and applications, to include but is not limited to Medicare, MediCal and Medicaid.

• Responsible for maintenance of National Provider Identifier (NPI) of all physicians and over 300 facilities through the National Plan and Provider Enumeration System (NPPES).

• Responsible for completion of monthly maintenance reports for Regional and Operational Managers


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ELECTRONIC DATA SYSTEMS, NHIC Medicare Account (April 2003 – August 2007)


Medicare Service Relations Supervisor

Appeals & Overpayments Unit

• Provided oversight to 20-40 employees for a variety of tasks within the department, including clerical support, written and telephone appeals examination and customer service for the state of California and Massachusetts

• Prepared monthly outlook for budget and finance departments; responsible for budget as provided by the Federal Government.

• Completed monthly, quarterly and annual financial reports for Centers for Medicare and Medicaid Services (CMS).

• Initiated telephone accountability group to ensure continuous improvement of quality service levels in order to satisfy demands of Medicare Providers and Beneficiaries in California and Massachusetts

• Initiated reorganization within Appeals team in cooperation with departmental managers which resulted in an increase in productivity and elimination of unnecessary calls.

• Created reports and presentations for upper management and customers which resulted in a better understanding of current procedures

• Facilitated meetings, reviewed all documentation and processes during the ISO Standardization process.

• Coordinated with counterparts in New England and California to create more efficient and productive processes

• Developed and implemented department database for reporting and trending of all Appeal cases which resulted in significant savings. Initiated meetings with the departments and gathered project requirements necessary.

• Devised department Workload reduction plan that resulted in 58% decrease in pending on-hand inventory

• Responsible for hiring and separation processes within the Appeals department and Overpayments Department

• Reviewed of new government implemented systems on model office for testing purposes. During this testing period initiated meetings with departments impacted by the systems. In addition to conducting training for all departments affected.

• Managed and led all projects government implemented and initiated within internal operations.

• Initiated frequent audit of current procedures and processes to produce efficiencies for the organization and ensure continuous improvement for the customers.

• Worked closely with Quality Assurance Trainer to ensure new employees were trained in compliance with regulations set by Customers and department

Medicare Provider Enrollment Analyst

Provider Enrollment Department

• Conducted on-site visits at provider practice locations including facility and equipment inspection, office personnel interviews, and made recommendations for approval of enrollment into the Medicare program.

• Conducted training for newly hired employees in the provider enrollment systems and other internal programs

• Educated new hires on policies and procedures for the enrollment process.

• Conducted assessment on system programs prior to release to ensure functionality.

• Reviewed pending workload to ensure all applications met timeliness requirements identified by CMS.

• Performed quality checks on selected applications to ensure that high service levels to providers and suppliers were maintained.

• Participated in a workload reduction project in a lead capacity, which resulted in a significant reduction in inventory prior to a major system conversion.

• Provided training to enrollment staff of new Provider Enrollment Chain and Ownership System (PECOS).

• Acted as a liaison with Palmetto GBA and CMS for the Railroad Retirement Board (RRB) workload.

• Interacted with physicians and medical group staff to resolve Medicare enrollment issues.

• Interacted with providers, provider representatives and government agencies (licensing boards, state and city agencies, etc.) during the enrollment verification process.

• Review of potential fraud and abuse, pre and post enrollment of providers to aid in the protection of the Medicare trust fund.

• Evaluation of new and current regulations to review for potential revocation actions


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• Assisted in Independent Diagnostic Testing Facility (IDTF) Revocation projects that has thus far resulted in significant savings to the Medicare program

• Assisted the Customer Service team in clarifying any issues or concerns representatives may have related to enrollment applications of providers or suppliers.


Colorado Technical University

Business Management degree in progress- Web based program