Medical Management

PATRICK R. WILLIAMS

**** ** ********* **.

Tigard, Oregon 97223

Contact:

******************@*****.***

503-***-**** Mobile

SKILLS:

Excellent oral and written communication skills. Exceptional organizational skills. The ability to

handle a large workload with ease. I adapt positively to any situation and with pleasant attitude. I

work well independently and/or collaboratively within a team environment. Superior at analytical,

and problem solving. I possess a strong work ethic, high morale, and friendly personality. I am

always seeking additional knowledge and challenges.

Multiple program knowledge(s): EPIC (Certified Super user), CEMR, Med Assets, Right Fax,

Lync, Amicus, Lotus Notes, Microsoft Outlook Office/Excel/Word/Power Point/Access (2003 &

2007), Word Perfect, Adobe/PDF file creation, Facets and Flowcast. Accurately type 60 wpm. I

have experience in office bookkeeping, Westlaw, Lexis Nexis, OJIN, and legal research by use of

multiple other legal/office resources.

EMPLOYMENT HISTORY:

Qmedtrix

Fee Schedule Research Analyst

05/2013 – Current

Duties include:

Responsible for conducting Legal/Medical research, prepare written documentation to support

research, provide reports on a regular basis for internal departments, and follow standard guidelines

in presenting analysis to organization. Obtain state mandated Medical Fee Schedules and updates

from various state contacts. Analyze, utilize and create Fee Schedules to determine how they relate

to company's bill review, reconsideration, negotiation software and client relations. Ability to

understand various types of payment methodologies in order to develop appropriate rules and

reason codes for system development, i.e., Professional, ASC, Outpatient and Inpatient. Produce or

update Fee Schedule Rules Analysis (FSRA) by entering results of fee schedule analysis into an

electronic format utilizing pre existing word processing templates. Conduct quality reviews

(audit/QA) of FSRA with team members in order to insure completeness and accuracy. Act as

primary, in company contact of FSRA for team members, leadership, executive team, technical

staff, all levels of management and clients. Organize and maintain files (e.g. orders, contracts and

vendor information). Processes new fee schedules, laws and regulations, coding books, and other

required documentation for all corporate departments. Assist in collecting and research of

electronic materials, periodicals and books by using telephone, fax, e mail and the Internet in order

to obtain materials in a timely and effective manner.

Providence Medical Group

Medical Management Trainer/Lead

05/2011 – 04/2013

Duties included:

Trained all new clinic staff of the Medical Management department delegations on the proceses of

CEMR file upkeep and EPIC Referrals, MyChart, City Call, and In basket requestsCreated

workflows and matrixes to ensure accurate referral processing, procedure guidelines and

documentation for assurance of compliance and medicare regulations.

I trained each new employee on the use of EPIC, CEMR and other systems. Coached and audited

employees work. Reviewed system generated reports. Audited clinical procedures for proper use of

patients insurance claims. Trained staff on correct medical coding and terminology of processed,

audited and reprocessed claims, referrals and orders. Generated correspondance to patients,

specialists and other medical staff. Contacted and supported all clinic providers and specialists,

legal representatives and insurance representitives as needed to research possible fraudulant misuse,

improvement or changes of guidelines. Established/created training materiels, updated files for

follow up as needed.

Regence Blue Cross Blue Shield of Oregon

Investigation & Recovery Services.

Lead Investigator/Team trainer/Management support

12/2002 to 05/2011

Duties Included:

Provided accurate and timely dispute resolution to TPL requests for claims processing, adjustments

and refunds. Complied to contract and administrative guidelines to correct payment and update

history. Review of system generated reports to ensure adjustments, refunds and edits are processed,

reprocessed, coded correctly and timely for accuracy of payment submission.

Generated letters to members, member representatives and providers as needed to process

adjustments and refunds. Sent requests for reimbursements and established files for follow up and

reconcile money received. Processed subrogation overpayments on accounts, notified members and

providers in writing of the overpayment; requested refunds, if applicable. Adjusted subrogation

recovery on previously paid claims.

Set up and upkept recovery cases/files in the system, created andsubmitted recovery letters to

ensure accurate and timely billings amounts owed to the company and maintained all supporting

documentation.

Referred accounts to collections, as necessary. Kept accurate and timely reports of transactions and

worked closely with finance and accounting to maintain accurate and balanced reports of claim

transactions. Assisted less experienced staff with questions, training, coaching, and the more

difficult or complex requests. Maintain confidentiality in all aspects of processing including any

follow up correspondence and contacts.

Updated changes in policies and procedures to ensure compliance with federal and state regulations.

Performed other research, analysis and adjudication functions as assigned. Identified any trends or

irregularities in the recovery and adjustment process.

Epiq Systems

(Part time Project position)

Legal Claims Reimbursements

Supervisor/Lead/Trainer

12/2007 – 12/2008

Duties included:

Trained (90) Legal Claims Analysts on how to analyze and process class action lawsuit claims. The

lawsuits included: Bankruptcy, Financial Litigation, Medical Malpractice, Insurance, and other

areas of litigation. My project was to create and implement a training system and training manual

for the new analysts.

Other duties included scheduling of the analysts work hours/breaks etc., the supervision and

delegation of the duties assigned and to ensure those assignments have been completed. Document

review, analyzing reports, as well as auditing of the claims completed by the analysts.

Allen Law

Support to The Honorable Judge Beth A. Allen

Paralegal /Legal Office Manager

12/2006 – 12/2008

Duties included:

File management, court filing, pleading: drafting/revision, client intake/correspondence, discovery,

receptionist duties, research, scheduling/docketing, errands, and client and opposing council

relations.

Miramont Pointe

Medication Aide – Caregiver/ Staff Supervisor

02/1996 03/2007

Duties included:

Followed the guidelines provided by the State of Oregon regarding medication rules and

procedures. Basic First Aid trained and administered CPR as needed. Assisted and designed care

plans for resident’s individual needs.

My role within this company varied, as a Medication Aide I would administer medications (oral,

topical etc.), RN delegated injections, blood sugar levels (CBG’s), injections (Insulin and other

prescribed medications) as prescribed by the residents physician. Supervised, supported, and

assisted four to fifteen caregivers per shift. Instructed the care staff and assigned them of their

duties, and ensured those duties were completed.

EDUCATION:

Marylhurst University – (2006 –2009) B.S. Business leadership. 3.7 GPA

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Everest College – (2004 2006) A.A. of Paralegal/Legal studies. 3.4 GPA

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East Bakersfield High School – (1990 1994) (Diploma) 3.2 GPA

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Regional Occupational Center (ROC) – Pre college requisites – (1991 1993)

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References are available upon request.

Contact this candidate