Customer Service Project Manager
Resume:
Patricia Anne Napoleone
P.O. Box ****
Sandia Park, NM 87047
Hm# 505-***-****, Cell# 505-***-****
Career Objective: Actively seeking a challenging position that will
utilize my management skills and experience, while offering potential for
continued career development and advancement.
SUMMARY OF PROFESSIONAL EXPERIENCE
o Premium Billing Specialist in Facet Systems
o Clerical Supervisor, Presbyterian Heart Group Epic Systems
o Managed Care Denial/Payment Variance
o Management of Daily Cash Flow/ Cash Applications
o Implementation of claims and customer service for health insurance
mergers: Blue Cross Blue Shield of New Mexico to HCSC, QualMed to
Health Care Horizons/Cimarron and FHP to PHP.
o Recruitment and Training of Employees in Contract Interpretation and
Processing Guidelines.
o Customer Relations -- Provider and Benefit Administrator
System Conversion and Configuration Claims
Identified claims conversion issues and documented resolution for GBAS,
Amysis, and Cerner systems. Researched claim history conversion issues.
Task force leader bringing cross-functional areas together to target
problems and recommend corrective action. Documented training materials
for processing guidelines.
Utilization Review
Review and analyze provider data for referrals and authorizations.
Direct appropriate information to medical director for final decision
Interact with providers, as well as members, for problem resolution.
Employment History:
Presbyterian Healthcare Services 2009-2011
Premium Billing Specialist
o Executes all functions with regard to premium billing and collection
activities including monthly billing, complex account reconciliation,
resolution of discrepancies with customers, aggregation of data for
broker commission processing, performing collection activities for
overdue accounts,
o Processing member and group terminations resulting from account
reconciliation, working with internal and external customers in
account resolution and maintaining accurate and timely metric
reporting
Clerical Supervisor, Presbyterian Heart Group
2006 - 2009
o Supervise 20 employees in areas of Billing/Coding, Scheduling, Front
Desk, & Medical Records
o Interview and hire clerical staff; prepare work schedules and
assignments, performance evaluations, and recommendations for
personnel actions when necessary... Oversee daily activities to
optimize productivity and censuses manage when appropriate.
o Maintain organizational and departmental policies, procedures and
objectives, including quality assurance programs, coordinate quality
improvement initiatives, monitor safety, environmental and infection
control standards and implement JCAHO compliance guidelines
o Accountability for daily business processes, PBO communication and
operational data analysis. Participate in strategic planning,
configuration and budget preparation.
o On-site resource for operational and departmental projects including
Lean & Six Sigma programs
Lovelace Health Systems 2002-2006
Manager, Managed Care Department
o Department Manager -- Two supervisory staff and 20 Patient Account
Reps.
o Manage and reconcile accounts -- update and document financial data,
perform customer service by contacting patients and insurance carriers
to ensure accurate reimbursement
o Utilize new technology methods, i.e., ImaCs, DDE, SSI, or Internet
resources, to ensure compliant billing/reimbursement.
o General accounting and bookkeeping skills, including posting of
charges, payments, contractual allowances, and credit
balances/refunds.
Supervisor, Cash Application
Supervisor for 32 Cash Posters -- Maintain daily Cash Flow Reports
Develop training materials and implementation of all payers.
Blue Cross/Blue Shield New Mexico 2000-2002
Customer Service Supervisor, BCBSNM
o Customer Service Supervisor for 19 employees
o Supervised unit activities to meet quality standards of service to
members and accounts.
o Project manager for Blue Chip computer conversion and configuration.
HCH 1999-2000
Claims and Customer Service Manager
o Implemented the claims, customer service, and enrollment functions for
the QualMed merger
o Trained staff to comply with new benefit plans and identified
irregularities.
Presbyterian Health Plan 1996-1999
Claims/COB Supervisor
o CMS Supervisor -- Managed 28 employees in the Commercial Claims and
Provider Care Unit.
o Recruited/trained staff for the acquisition and implementation of the
FHP business to PHP.
o Lead computer conversion task force identifying issues and
recommending solutions for improved productivity.
Lovelace Health Systems 1993-1996
Claims Processor
o Responsible for processing payment for, patients, and hospital claims.
Responsible for providing any information (medical records, itemized
statements, etc) requested by insurance companies to process claims.
Maintain a system to ensure timely follow up is completed for each
outstanding claim.
Education:
UNM Business 1971-1973
Certification in Claims Processing and related PC Programs
Skilled in Microsoft and Medical Program Applications
Attended HIPAA Federal and State regulatory requirements classes
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