Manager Customer Service
Resume:
REBECCA HARMON, CPC
Lawrenceburg, Indiana 47025
SUMMARY
Versatile operations manager with extensive experience in customer service,
provider education, process improvement and employee development. Strong
problem resolution skills and the ability to effectively manage day to day
operations while keeping focused on the short and long term goals of the
organization. Involved in the start-up of a new business (Paragon Health
Systems) including staffing, standards, procedure development, and
establishment of service targets.
PROFESSIONAL EXPERIENCE
National Government Services 2000-
present
A Medicare contracted Part A intermediary, Part B carrier, Regional Home
Health and Hospice intermediary and DMEMAC government contractor. National
Government Services supplies claims processing, medical review and provider
contracting and education to beneficiaries and providers in multiple CMS
jurisdictions. There is comprehensive oversight and strict government
regulations that require compliance with federally mandated laws and
standards for each department.
Manager, Provider Outreach and Education (POE)
Responsible for the Durable Medical Equipment and Clinical Provider
Outreach and Education/CERT department, including staffing, structure,
processes and oversight.
. Create a structure that includes Part A, RHHI, Part B and DMEMAC staff
and functions.
. Develop a referral tracking system to allow incoming and outgoing
referrals to internal departments within National Government Services.
. Create a structure to interact with Medical Review for data analysis
and follow up from complex medical review.
. Create a structure to allow global education through the clinical and
general POE departments.
. Establish a process to allow the combined oversight and interaction
for the Part A, Part B and DMEMAC CERT processes.
. Responsible for department staffing, budget, workload and quality
review.
. Selected to participate as a team lead in the preparation for the
competitive bidding process for multiple jurisdictions. This project
allows NGS to maintain its current regions and expands it's regions
for Medicare operations.
. Developed a companywide Subject Matter Expert list and assigned teams
to create integrated education material for NGS global training.
Manager, Part A Medical Review
Responsible for managing the Part A Medical Review department with a direct
reporting staff of 30 employees including nurses, team leads, data
technicians and administrative staff.
. Developed provider education program including the nation's first
Medicare CD desk top education tool.
. Implemented a proactive Quality Improvement plan. This includes
monthly quality council meetings to discuss validation of internal
controls and progress towards goals.
. Implemented a mentor program involving each Team Lead to build future
department leadership.
. Maintain budget in excess of three million annually.
. Complete monthly budget forecast to ensure performance within 5
percent of budget for each cost center.
. Initiated employee suggestion program as part of the FISH philosophy
of enjoying time at work.
. Developed a productivity tool for each associate and comparison to
peer results.
. Created annual problem focused strategy with specific goals for each
identified area of concern.
. Developed team structure to allow each team to focus attention on
intervention planning to meet their problem focused goal.
. Participate on national workgroups for error rate reduction planning,
Medical Review Leadership and reporting format development.
. Foster a strong control environment to ensure compliance with
government oversight regulations.
Manager, Part A Appeals
Responsible for managing the Part A appeal department with a staff of 10
employees including nurses, specialists, hearing officer, quality and data
analyst and clerical staff.
. Implement process improvement to ensure compliance with all CMS
standards.
. Implement MIC structure to measure and improve individual performance.
. Create and implement resolution to any vulnerability identified by CMS or
internal audits.
. Develop individual goals for productivity, growth and quality for each
team member.
. Communicate changes and ensure all staff members receive the most current
and complete information available.
. Identify areas to focus provider and beneficiary education through
interpretation of data analysis of appeal reversal rates.
. Operate within the budget parameters available through the yearly budget
allocation through CMS.
. Create the AdminaStar Federal appeal website and oversight of any
additions.
PARAGON HEALTH SYSTEM 1997 - 2000
A joint venture company of Anthem Blue Cross and Blue Shield and Group
Health Associates formed to administer health insurance for members of
Anthem, Pacificare and Prucare. Paragon has 300 employees who handle
membership, enrollment, customer and provider service, and utilization
management and network development.
Operations Supervisor/Manager
Responsible for managing a staff of 30 employees including supervisors,
team leaders and customer support personnel.
. Developed a streamlined training process that allowed 50% decrease in
training time with improvement in department goals of average speed of
answer, abandon rate and blockage and no decrease in accuracy.
. Implemented a company wide standard for external written communication.
. Created the first Cincinnati medical group Service Guarantee that was
successfully implemented within budget.
. Conceived and developed the Provider Inquiry department which had the
mission of serving local physicians and hospitals with a focus on
delivering superior service. Created the structure, staffed the
department and served on the management team.
. Maintained staffing levels to ensure efficient operations within budget
and customer satisfaction.
. Consistently met National Management Standards for Average Speed of
Answer of 30 seconds with less than 5% abandon and less than 8% blockage
despite higher than normal turnover.
. Served as team lead on a project to train employees to use complaint
codes consistently. The team was able to identify most frequent
complaints and focus on appropriate solutions. The process was adopted
statewide by Anthem.
. Prepared and evaluated GHA reports, weekly and monthly NMIS reports, and
monthly complaint tracking reports.
. Coached, counseled, motivated and prepared and administered performance
reviews and corrective action plans for employees.
. Facilitated corporate process improvement teams in the following areas:
appointment availability, smoking cessation, external correspondence,
complaint tracking and trending, Paragon culture, and operations
incentives.
GROUP HEALTH ASSOCIATES (Cincinnati, Ohio) 1978 - 1997
The area's largest multi-specialty group practice with 90 full time
physicians and nine locations.
Patient Services Manager (1987-1997)
Senior Patient Services Representative (1985-1987)
Patient Services Representative (1983-1985)
. Created a smoking cessation program with a five-year 40% success rate.
. Served as a member of a three person team that created the operations
area and the core team that created an insurance product and the Anthem
100, 200 and 300 network concept for a joint venture company that became
Paragon.
. Managed daily department functions such as staffing and developing
department members to be able to handle approximately 2000 calls per day.
Several past staff members have been promoted.
. Established and maintained call center benchmarks using NMIS standards.
. Participated and encouraged continuous quality improvement teams and
training using Continuous Quality Improvement methods.
. Reviewed denied claims and coordinated and prepared documentation for
patients' appeals of denied claims.
. Resolved patient complaints by documenting and sending to department
directors. Created monthly reports, patient responses and served on a
root cause analysis team.
Appointment Coordinator (1979-1983)
Responsible for scheduling appointments for a multi-specialty group
practice. Created schedules, maintained meeting files, edited employee
newsletter and conducted callbacks.
Receptionist (1978-1979)
Responsible for answering and directing heavy telephone traffic, greeting
patients and maintaining same-day scheduling and messages.
EDUCATION
Wilmington College (Cincinnati, Ohio)
University of Cincinnati (Cincinnati, Ohio)
AdminaStar Federal Strategic Leadership Program, Indiana University
IUPUI Project Management Certification Program
American Association of Certified Coding Boot camp
Yearly Seminars and Training in Management and Business Administration
Anthem Blue Cross and Blue Shield's Leadership Training
Extensive Training as a CQI Facilitator and Project Management
COMMUNITY ACTIVITIES
. Indiana Stroke Prevention Tasks Force
. Booster for Harrison Youth Football
. Friends of Football, East Central High School, Past President
. Recording Partner, Logan's Business and Professional Women's Investment
Club
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