KAREN D.A. BLACKETT

*** **** ****** *** ** Brooklyn NY 11203 • 718-***-**** • ac31ou@r.postjobfree.com

EMPLOYMENT

ADMINISTRATIVE IS COORDINATOR 02/11-CURRENT

Greater New York Hospital Association New York, NY Point liaison between all internal departments, outside vendors and accounting staff members. Arrange and schedule meetings and conferences for officials with the organization or between companies.

Maintain all IS databases of end user inquiries and create end of year reports using SysAid. Prepare and monitor all approved expenses made by the VP of IS. Make sure projects are progressing effectively and completed by deadlines. Prepare invoices, spreadsheets of client accounting and contact information. Communicate information to staff either using email or phone. CONTRACTS SPECIALIST 01/10-02/11

Innovatix, LLC/Greater New York Hospital Association New York, NY Processed pharmacy paperwork and followed up with vendors to obtain eligibility in order for members to gain access to contracted pricing.

Responsible for resolving contract attachment and pricing discrepancies on behalf of members. Consistently analyzed member purchases to ensure access to best wholesaler pricing. Built relationships with assigned pharmaceutical wholesalers and vendors to obtain approval for eligible contracts and access to available pricing at time of purchase. Identified additional credits for members with the use of monthly wholesaler audits. Worked directly with account managers and field staff on behalf of members. BILLING ADMINISTRATOR 09/09-12/09

Health Diagnostics New York, NY

Responsible for scheduling appointments via the telephone, in person or other means. Greeted and registered all patients arriving to their Open-MRI appointments. Prepared and updated all patients charts relative to appointments, procedures, results, physician encounters and referrals whilst working independently within specific timeframes. Escorted or directed patients to examination rooms. Administered front office operations including answering phones, filing, faxing and retrieving of medical record requests.

Posted payments related to each MRI visit whether Commercial, Workers Compensation, No Fault or Self Pay. Whilst applying any necessary co-payments or transportation fees. Scanned all paperwork consisting of photo ids, insurance cards, referrals, authorizations and reports into each patient profile.

Troubleshoot all billing issues referred to collections. Knowledgeable of commercial insurance plans including Medicare and Medicaid. PROVIDER RELATIONS FIELD REPRESENTATIVE 05/08-08/08 Affinity Health Plan Bronx NY

Served as a plan liaison to an assigned panel of contracted providers whilst providing prompt problem identification and solutions to all matters.

Negotiated contracts for Article 28, Primary, Specialty and Ancillary Care, Individual Primary Care Providers and Individual Specialty Providers.

Conducted orientations or re-orientations sessions for providers and key administrative staff. Reviewed and analyzed qualitative information to access provider performance and made recommendations for Plan action.

Collected and reported information in order to assure plan provider database was accurate and current. Participated in departmental projects including but not limited to Provider Access and Provider Availability Studies and Provider Directory information.

AUTOMATION MANAGER OF PROVIDER CREDENTIALING 07/06-04/08 HIP/GHI/Connecticare New York, NY

Performed periodic automated uploads of provider data from CAQH pertinent to regulatory reporting, UPIN, MMIS, DEA, NYS Licensure, Malpractice and Board Certification. Audited departmental computer system input regarding verifications, applications and updates of provider files.

Provided web-based research for primary source verifications based on NCQA standards. Monitored the following web sites for provider related sanctions, NPDB, OPMC, OIG/OPM, Medicare, Medicaid, New York State and NJ Board of Regents.

Presented providers subject to either continued participation, discontinued participation to the Medical Director for review followed by presentation to the Credentialing/ReCredentialing Committee. Implemented the creation of the Paperless Credentialing process which helped to improve the credentialing workflow cycle time, reduce administrative costs whilst improving provider satisfaction. ADMINISTRATIVE COORDINATOR/MANAGER 01/03-06/06

HIP Health Plan of Greater New York New York, NY

Developed new Microsoft Access queries and captured the age of our pending medical claims reports. Provided support as a liaison between the HIP Relationship managers and the IPA’s of Lenox Hill, Partners in Health and Continuum.

Tracked all incoming facility medical records received for nurse review then assisted with the preparation and presentation of member appeals to our external peer review. Independently, requested medical records from hospital regarding inpatient and emergency room stays. Trained new or existing employees on company IT programs. EDUCATION

Hunter College CUNY New York, NY 09/87-02/93 - Incomplete Richmond Hill High School Queens, NY 09/84-06/87 - Diploma SKILLS

Microsoft Office Suite Facets Consolidated Provider File Cognos ePaces Microsoft Project

Winucs Amisys Cactus

Climacs Qcare LEAN

Lotus LEADS

Contact this candidate