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Customer Service Project Management

Location:
Cleveland, OH
Posted:
March 21, 2018

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Resume:

PROFESSIONAL SUMMARY:

Highly efficient Project Analyst with ten years’ experience in the medical industry. Strategically focused, results-driven, and disciplined analyst with proven ability to manage human and operational assets to achieve organizational goals. Excellent verbal and written communications skills- proficient at performing liaison functions and coordinating project activities with multiple teams. Logical, analytical, and thorough-adept at setting priorities, organizing tasks, and managing multiple projects in a fast-paced demanding environment. Articulate, persuasive and experienced at presenting highly complex data and findings to top management. Proficient in Microsoft Excel, PowerPoint, Outlook, Visio, and Word. Expert knowledge of database systems such as Xpeditor, HARP and Patient Advocacy.

EDUCATION:

University of Phoenix- Bachelor of Business Admin –Project Management 2018

University of Phoenix- Undergraduate Project Management Certificate 2017

Lorain County Community College - Associates of Science Business Management 2014

Remington College - Medical Insurance and Coding Diploma 2007

EMPLOYMENT HISTORY:

Quadax Inc., Middleburg Hts., OH

2007-Present

Revenue Cycle Services Project Analyst

2015- Present

Manage and Analyze Government payer management: Analyzing open AR for Medicare, Medicaid Medicare Advantage and Managed Medicaid plans, implementing policies and procedures for production teams, and resolving contractual payer issue.

Maintain contract templates and quality of data in contracts maintenance. Providing updates, alerts and reporting to internal team members, Director of Reimbursement and Vice President of Operations and Finance.

Monitor contract expiration dates and notifies departments accordingly about processing deadlines.

Identify and resolve problems while maintaining workflow processes with minimal direct supervision.

Document and communicate workflow change requests.

Perform Project Management and recommend process improvements

Write, maintain and support a variety of reports or queries using one or more established system.

Preform training to clients on new processes/functionality, and develop user procedures, guidelines and documentation.

Contact appropriate personnel to solve specific system issues.

Leads the preparation and assists in the presentation quarterly client meetings.

Lead and maintain meeting agendas and notes for weekly and monthly meetings both with internal and external teams.

Escalates any client-related issues to senior management and keeps them informed of the status of problems, significant plans, and meetings, as well as client organizational changes.

Complete monthly Payer SWOT analysis based off of low reimbursement and/or high open A/R.

Communicate payer issues and resolutions one on one with client, as well as internally with Production teams.

Manage task list for Payers, Client Service Teams, Production teams and client.

Conducts and administers client billing each month in collaboration with the Finance team.

Helps identify new or additional reimbursement opportunities

Introduction into various projects including interface setup, payer claim form corrections and portal registration/access.

Fulfill requests for ad hoc reporting using advanced spreadsheet functions such as pivot tables.

Assist in developing and execution of operational concepts, including the creation of dashboards to meet client specific client requirements and needs.

Work closely with Account Executives, company Director and VP to monitor progress of client goals, objectives, discussions with team members and external client personally on a regular basis as well as monthly, quarterly and yearly goals, object.

Conduct thorough research and provide accurate reports.

Assist in training new team members and for their role as it relates to payer management, as well as crossing training members as backups. This includes team members such as Project Analyst, Project Managers, Production Managers and entry level Production team members.

Communicate with the client on contract discrepancies

PAS Insurance Analyst

2014-2015

Complete provider enrollment for EDI services such as electronic claims, remittances and electronic funds transfers.

Respond to client requests and questions to make sure satisfactory customer service.

Identify new insurance codes to be added to each database based of their need.

Completed EDI enrollment forms (both paper and electronic) bring client database up to a standard of 85% electronic submission and remittances.

Revenue Application Service Support

2010-2014

Create account related reports in order to quantify potential payer issues.

Respond to client requests and questions to make sure satisfactory customer service. Investigated high accounts receivables and assisted in finding solutions to correct the billing issues.

Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement.

Reviewed unidentified remittance files received from payers so that they could be released and posted to outstanding A/R.

HARP Production

2008-2010

Initiated calls to insurance to check payment and claim status to make sure claims were adjudicated correctly.

Reviewed unidentified remittance files received from payers so that they could be released and posted to outstanding A/R.

Performed full-cycle medical billing in a fast-paced medical billing company

Applied payments, adjustments and denials into medical manager system to reduce the aged accounts receivables.

Reviewed unidentified remittance files received from payers so that they could be released and posted to outstanding A/R.



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