Medical Assistant Management
Resume:
Kathleen M. Gibson
Kathleen M. Gibson
Cincinnati, OH 45209
*****.********@*****.***
Motivated, dedicated, and confident professional with a broad and unique skillset in the healthcare industry,
producing quality outcomes through networking, innovation, and personal and professional drive for excellence
in healthcare.
PROFESSIONAL EXPERIENCE:
Humana, Inc.
Cincinnati, Oh
Medicare Provider Relations: April 2005-Present
Responsibilities include territory management for Medicare Advantage Providers for Dayton, Cincinnati,
Northern Kentucky, S/E Ohio and S/W Indiana . Assist in the design and implementation of programs to build
and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and
practice managers. Support those who direct and implement strategies relating to the development and
management of a provider network, identify gaps in network composition and services to assist the network
contracting staff in prioritizing contracting needs, and researching and remediating claims.
Other Role Responsibilities:
Identify Key Performance Indicators and use pertinent data and facts to solve a range of problems.
Serve as focal point for Provider risk group questions regarding financial settlement, physician reward
program, and funding.
Train providers regarding reports and data sets available through the appropriate internal accounting
applications.
Provide operational support for Market Point Medicare Advantage sales managers and agents in order to
positively impact growth in membership.
Major Accomplishments:
Assisted in implementation of the Medicare HMO plan in Cincinnati effectively educating over 2,000
physicians on HMO product parameters and guidelines.
Effective in migrating 2,000 providers in the Cincinnati market on the continuum from Private Fee for
Service to Medicare PPO to Medicare HMO and on to path to risk agreements.
Led project management for the introduction of the Passive PPO plan to providers for the OPERS
members.
Recognized as a STARS award recipient for OPERS provider education.
Actively participated in the education of providers in Kentucky and Florida for Kentucky Teachers
Retirement System increasing membership by 20,000 for the Kentucky market.
Humana, Inc.
Cincinnati, Oh
Network Operations Representative June, 2004-April, 2005
Responsibilities included assisting in collecting and formatting data in accordance with department needs.
Manage and monitor internal communications. Maintain databases for tracking and trending purposes. Create
Kathleen M. Gibson
and review reports tracking new physician, hospital and ancillary contracts. Assist management in development
of new physician networks. Assist with auditing process to ensure database integrity. Review current internal
processes and assist in any process improvement opportunities.
Major Accomplishments:
Implemented state wide provider seminars giving physicians, office personnel and practice
administrators an opportunity to learn about any product changes, new plan roll out or general
healthcare industry changes.
United HealthCare
Cincinnati, Oh.
Network Account Manager Feb, 2001-Jan, 2004
Responsibilities included managing relationships with individual physicians and medical groups paid on a fee-
for-service basis. Facilitate and complete financial analysis of all reimbursement proposals. Determine network
adequacy and recruit new providers to fill any identifiable gaps. Maintain strong working relationships with
ancillary departments throughout United Healthcare, as well as United HealthGroup relative to claims
resolution and contract load activities. Identify provider education opportunities, and coordinate and deliver
appropriate training materials. Prepare and facilitate operational meetings with the providers.
Paragon Health System
Cincinnati, Oh
Provider Relations Representative, March, 1998-Feb, 2001
Responsibilities included front line support for the network management department of Paragon Health System,
medical management company for Anthem in Cincinnati. Coordinated credentialing activities. Conducted
claim research. Helped spearhead a recontracting project of over 4000 area physicians.
Kindel Dermatology
Cincinnati, Oh
Medical Assistant, November, 1994-March, 1998
Responsibilities included acting as main surgical assistant to two physicians in a high volume, fast paced
dermatology practice.
Responsible for educating patients and training staff.
EDUCATION: Associate Degree, Medical Assistant
Northwestern College, Lima, Oh-
ADDITIONAL EXPERIENCE, KNOWLEDGE AND SKILLS
• Medicare Risk Adjustment (MRA)
• Comprehensive Primary Care Initiative (CPCI)
• Healthcare Effectiveness Data and Information Set (HEDIS)
• Centers for Medicare and Medicaid Services (CMS)
• Proficient in Excel, Word, Access, CAS, EMPI, PAAG, CGX
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