Customer Service Quality Assurance

*** *** ******** ****, ********, NY845-***-****(*********@***.**.***

Jean Mertine

Objective

Through out my work history, I have strived to increase my knowledge

through taking on new tasks, self-education and college courses. I

especially enjoy work requiring attention to detail, complex research,

and anything which requires quality workmanship as opposed to production

quotas. In an ever-changing work environment, I am continually seeking

additional education enabling me to better work in various positions.

Professional Accomplishments

Management

creating a business from the ground up,

researching all State and Local Health Care Laws and Rules,

providing education and training to all staff members on all aspects of

office and health care business operations,

researching electronic billing programs and handling of the electronic

billing,

handling all of the accounting aspects of the office,

maintaining customer files and medical records,

maintaining HIPAA compliance,

applications to all insurance companies for participation,

maintaining all staff certifications and licenses,

creating all office policies and procedures,

creating all office forms,

application for State Tax Identification number,

coordinating all office support for local charities and events,

handling of all advertising and marketing aspects,

handling all customer service aspects,

working directly with customers and sales representatives,

JCAHO Coordinator and maintain all of the aspects associated with JCAHO

Standards and Accreditation.

Records Management

maintaining existing student records in databases;

closing/consolidating student records;

maintaining individual behavioral/incident files,

maintaining secondary files on all students,

completing and consolidating annual state surveys;

responsible for data/completion of the following reports-BEDS; PD-2A/4;

PD-5; PD-5B; PD-6; PD-8, Annual Survey of Children in Local Institutions

for Neglected or Delinquent Children; Annual Survey of Prevention and

Intervention Programs for Children and Youth; other surveys as

requested;

organize and open new student records;

scheduling interviews;

distributing referral records,

processing new admission packets;

holding/monitoring intake interview files;

informing School Districts if the IEP is incorrect;

processing discharges;

tracking "aging-out" students;

yearly census report;

admissions referral database,

annual notice of rights,

documentation from the NYS Office of Temporary & Disability Assistance

and DDP2;

processing guardianship papers;

tracking and distributing psychological reports;

AAC consult evaluations;

maintaining and updating SOP manual;

monthly preparation of the Psychiatric Hospitalization Report;

Credentialing

All initial credentialing and re-credentialing aspects for physicians

and nurse practitioners

verifications of licenses;

national practitioner data bank;

malpractice;

physicals;

education;

CME;

affiliations;

references;

AMA;

UPIN;

Executive Assistant

Inputting statistical information into the access database for the

present year,

creating reports from the access database,

preparing packets and minutes for the Commission meetings,

scheduling appointments for the Director of Nursing and the Medical

Director;

maintaining Quality Assurance Reports;

maintaining the Nursing Schedule utilizing the Schedule Optimizer

program;

maintaining the job specifications;

organizing and preparing the meeting packets for the weekly Unit

Managers meetings;

maintaining all relative medical record information for billing of

services rendered at the North East Center for Special Care;

providing secretarial support for the physicians and nurse

practitioners;

weekly physician service roster;

credentialing support for physicians;

monthly calendar of hospital meetings;

Maryland Indicator assessment reports;

JCAHO Alerts master list;

QI and QP reports;

computer graphics for presentations;

maintaining and ordering supplies.

I was also responsible for organizing and preparing the meeting packets,

agendas, food requests, meeting locations, minutes, executive summaries

and memos for the following hospital committees: Board QA QI; Medicine;

Infection Control; Accreditation; Medical Staff QA QI; Pediatrics;

Family Practice; OB/GYN and Total Quality Management.

Insurance

Extensive knowledge of the health insurance plan covering the state

employees and national retirees from the State of New York;

customer service including telephone and correspondence;

individual and group provider relations;

claims input with training on adjustments of claims and payment;

coordination of benefits and crossover processing of various carriers

including managed care organizations and Medicare;

investigation and resolution of claim discrepancies,

in house training on the processing of claims for the following

specialties - infertility; chemotherapy; hemodialysis; surgery;

podiatry; outpatient mental health and substance abuse;

primary office liaison with vendor responsibilities for providing

medical necessity for procedures requiring pre-qualifying review;

review of appeals in regards to noncompliance for pre-qualifying claims;

responsible for statistic data collection and reporting as defined from

time to time by the office;

explaining plan benefits to enrollees for physical therapy, chiropractic

and occupational therapy,

Medicaid and Medicare as secondary insurances, Orange and Ulster school

districts;

data entry and processing of authorizations

Employment History

03/08-present Secretary Kingston City School

Central Registration District Kingston, NY

Special Education

12/07-03/08 Call Center ACN/United Healthcare

Representative Kingston, NY

02/07-12/07 Student Records Anderson Center for Autism

Manager Staatsburg, NY

05/06-02/07 Executive Assistant Northeast Center for

Special Care Lake Katrine,

NY

05/05-05/06 Credentialing Imaging On Call, LLC

Coordinator Poughkeepsie, NY

08/03-present Owner It's All About You

Kingston, NY

08/00-05/05 Office Coordinator Benedictine Hospital

Kingston, NY

01/00-08/00 Administrative Ulster-Greene ARC

Assistant II Kingston, NY

Education

5/1981 Business Office Skills Ulster County Community

Technology College Stone Ridge, NY

Computer Skills and Systems

Affinity Patient Accounting System

Mede Soft

Quest Billing Software

Web MD Billing Software

SSI Billing Software

Sungard

Wordperfect

Microsoft Excel

Publisher and Printshop

Microsoft Access

Microsoft Word

Finance Manager

SASI

eSchool

COMPUTER SKILLS:

Competent with typing, filing, communication, organization, and

marketing. Recent typing test indicated average speed of 58 wpm with no

errors.

Comfortable and competent with various office machines such as copy

machines, multi-phone lines, Dictaphone.

Computer literate with various software programs available to the

public.

Data entry

Recent testing on timed tests for accuracy and speed indicated

120/characters per minute data entry, no errors; calculator testing

indicated 36 columns of input with no errors.

Licenses and Certificates

Notary Public through 2013

Weight Watchers Receptionist since June 2009

Weight Watchers Leader since August 2009

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