Manager Customer Service

Susan Collins

***** ********* ****** ****, ** *4011

Home 440-***-****

Cell 440-***-****

E-mail: **************@*****.***

Management, Training, Operations, Healthcare and Business Administration,

Federal Navigator for the Affordable Care Act-2013

Professional Summary

Management/Supervision

. Successfully managed frontline operations staff in financial and

health care industries.

. Recruiting, hiring and training of staff in financial and health care

industries.

. Addressed internal problems quickly until issues were resolved.

. Project management.

. Maintained excellent rapport with all stakeholders. i.e. management

staff, co-workers, customers and patients.

. Budget planning and supply and maintenance of IT hardware and

software.

. Ability to prioritize and organize, co-ordinate resources and empower

others.

Training/Development

. Implemented policy for skilled nursing facility that decreased call-

offs by 95%.

. Implemented new company HIPAA policy for NeuroControl.

. Collaborated with Aetna Health Insurance and devised coverage policy

for NeuroControl and their Freehand System for spinal cord injury

patients.

. Performed background checks of new hires and conducted new employee

orientation to familiarize new employees with safety, HIPAA and OSHA

guidelines.

. Additional experience includes 10 years at large area hospital in

admissions, bed control and pre admission testing and surgery

scheduling.

. Enrollment experience for third party insurance administrator.

. 10 years experience in patient registration/admissions at Fairview and

Lutheran Hospitals.

. Successful in implementing policy coverage with major insurance

carriers.

Professional Experience

CUYAHOGA HEALTH ACCESS PARTNERSHIP, Cleveland, OH

ACA NAVIGATOR, 11-13 to Present

. Enroll Consumers into the Affordable Care Act.

. Do appeals to the Marketplace regarding ACA issues.

. Enroll OH Consumers into expanded Medicaid.

. Assist consumers with enrollment into CHAP program via their primary

care physician.

. Provide Consumers with other social services they need in the

community

NORTH COAST HEALTH MINISTRY, Lakewood, OH

DIRECTOR OF OPERATIONS, 1-2013 to 10-2013

. Management of clinical operations. Worked with Medical Director and

Chief Nursing Officer to promote optimal clinic flow and development

and implementation of clinic procedures.

. Ensured execution of clinic programs to grant/program specifications.

. Managed patient centered medical home procedures, documentation and

data analysis required to maintain certification as a patient-centered

home by NCQA.

. Communicate with Volunteer Coordinator on volunteer staffing and

training needs of volunteers.

. Oversee implementation of policies and procedures for all aspects of

clinic operations.

. Supervised staff of 10-which included Office Manager, front desk

staff, MA's, Pharmacy Tech.

. Worked closely with IT vendor to ensure optimal functioning of clinic

computer systems.

. Worked with EPIC system which is the Cleveland Clinic EMR system,

Worked with enrolling patients into the CHAP program for specialty

care.

. Implemented several policies and procedures to efficiently and

effectively manage day to day clinic operations.

. Proficient in EPIC, Misys, Framework and CHAP software.

CAMBRIDGE HOME HEALTH CARE, Middleburg Hts., OH

IN-HOME PROGRAM MANAGER, 2012-2013

. In charge of the internal sales process, manage the inquiry process

including

screening and prioritizing potential clients.

Conduct 5 or more sales calls a week in the community to meet sales

goals for agency to increase revenue.

. Manage the day-to-day operations of the In-Home Program which

includes oversight of the in-home consultations by nursing staff

and set up of care plans for the home health aides.

. Manage the recruitment process to ensure that the program maintains

an adequate number of employees to meet demands for client

services.

. Coordinates and participates in the orientation for new employees.

. Oversee the Case Coordinators to ensure cases are covered with

appropriate staff and that staffing is complete on a daily basis.

. Interact with clients to ensure customer satisfaction.

. Oversees daily service delivery and perform or assigns in-home

visits as needed.

. Ensure that the department is run in compliance with all external

regulations including wage and hour regulations.

. Perform quarterly audits of patient and employee charts.

. Establish a yearly budget and manage the agency according to the

established budget.

. Enter OASIS's into the HAVENS system for Medicare for weekly export

to CMS.

. Ensure authorizations are worked properly fro Medicaid, including

State Plan, Waiver and PASSPORT.

. Ensure constant communications with Case Managers at Medicaid,

Passport, Caresource and other funding sources.

BAYADA NURSES, Independence, OH

CLIENT SERVICES MANAGER, 2011-2012

. Plan and direct the office and field staff (15 direct reports).

. Increased agency revenue by ensuring Face-to-Face process was in place

and to ensure CMS guidelines were followed for this documentation.

. Implement and monitor key performance improvement plans

dealing with issues found during JCAHO and CHAPS yearly reviews.

. Ensure staff is following CMS guidelines when completing OASIS forms

during start of care and afterwards for billing.

. Demonstrate and communicate the core values of Bayada Nurses.

. Expert in HomeCareHomeBase and Salesforce.

. Develop and grow caseload.

. Intake of referrals for agency using Allscripts.

. Effectively schedule staff and manage caseload.

. Maintain effective fiscal management of caseload and office

operations.

. Managed HR functions and payroll for agency.

. Provide administrative supervision and support to field employees in

positive partnership with Clinical Managers.

. Acted as interim Director from 8/11 till office closed 1/12 when

former Director resigned.

. When this agency closed, I was the facilitator to ensure the agency

was closed and all aspects of the office closing was complete.

AMEDISYS, INC. Westlake, OH

OPERATIONS MANAGER, 2009-2011

. Responsible for planning, directing and controlling the staff (12

direct reports), billing and office functions.

. Direct services and operations for the branch including billing,

purchasing, communications systems, space utilization, information

technology and shipping services.

. Coordinated systems and procedures with medical records, data entry,

claims review and personnel functions to ensure efficient operations.

. Monitor referral sources from calls, faxes and via Allscripts/ECIN.

. Direct supervision and of non-clinical and clinical staff.

. Expert in Peoplesoft software.

. HR - candidate selection, interviewing, hiring, training and

terminations.

. Payroll

. Coordinated systems and procedures.

PLANCORP, INC, Valley View, OH

CLIENT SERVICES - EMPLOYEE BENEFITS, 2008-2009

. Service employer groups with health insurance benefits

. Claim denials, enrollments and benefit troubleshooting

. Request quotes from medical and ancillary insurance carriers for best

renewal rates for companies seeking best rates for health care

benefits

. Quote requests for individuals seeking health coverage.

GOOD SAMARITAN HEALTH GROUP, Avon, OH

BUSINESS OFFICE MANAGER/MEDICAL RECORDS DIRECTOR, 2007-2008

. Responsible for all Accounts Receivable and Payable functions.

. Revamped Medical Records department to improve efficiency.

. Responsible for payroll and transitioned to ADP payroll system.

. Managed financial and operations staff.

. Oversaw all vendor contracts/licenses and physician license

credentialing.

. Ensured HIPPA standards met for resident charts.

QUADAX, Fairview Park, OH

PATIENT ADVOCACY, 2005-2007

. Evaluated denied clinical claims and identified payer's appeals

process and timelines.

. Researched regulations at the state and federal level and formulated

arguments to challenge payors claim denials.

. Perform data analysis documenting appeal trends.

. Proficient in OnBase.

. Processed clinical appeals.

. Collaborated with three major insurance carriers to implement policies

to cover breast cancer assay.

Education

Bachelor of Science in Psychology - Baldwin-Wallace College, Berea, Ohio

Certifications

Certificate in Lean Six Sigma - Black Belt Level, completion date May 2014

Federal Navigator for the Affordable Care Act

Honors and Awards

Received recognition by newspaper in New Jersey for patient advocacy

Received numerous customer service awards

Community Activities

Volunteer teacher for Cleveland Catholic Diocese PSR

Volunteer class representative for alumnae association at former high

school

Contact this candidate