Project Management Quality Assurance
Resume:
Tresa J. Powers
Eastpointe, MI 48021
Phone: 313-***-****
Email: *******@*****.***
» Professional Strengths
Healthcare professional with over 25 years of experience with compliance, vendor management and the Affordable Care Act
Proven success in business analysis, grievances and appeals
Extensive project management experience with meticulous attention to detail
Effectively developed new employee handbook, efficiently implementing and tracking compliance of office processes and procedures
Experience performing complex compliance research and regulatory analysis to ensure consistency with group and product guidelines to remain compliant with NCQA standards
Experience researching cases and preparing presentations for administrative law judge hearings, as well as present case before the administrative law judge
Managed the overall evaluation establishment and implementation of new and improved workflows process, reporting systems and new products
Processed client appeals and billing according to the National Committee for Quality Assurance (NCQA) standards
» Education
Baker College—Auburn Hills, MI
Associate of Medical Administrative Management
» Professional Experience
Henry Ford Health Systems 04/20-Present
Medical Secretary Supportive Oncology Services
Effectively maintain multiple phone lines while utilizing proper telephone etiquette, while screening & directing calls as well as making appointments
Accurately and efficiently schedules appointments for a large team
Answers basic and complex patient questions or concerns
Triage incoming phone calls, mail, faxes and emails as well as creating electronic files for said mail
Maintain patient confidentiality and integrity as mandated by the HFH
Creates value for patients and exceeds patient expectations. Handles multiple customers effectively with tact, respect and sense of urgency
Redirects patients to appropriate sources if necessary
Perform related general office duties, such as monitoring & ordering standard supplies, operating office copier, submit invoices for PO#s and requests for payment
Create and ensure consistent master schedules for all team providers while maintaining the standardized and consistent scheduling practices, protocols and procedures
Henry Ford Health Systems 05/19-04/20
Data Coordinator
Developed the position, created policies and procedures
Triage incoming mail, faxes and emails as well as creating electronic files for said mail
Maintain patient confidentiality and integrity as mandated by the HFHS
Problem solve, as well as prioritize work for the Utilization Review Team
Follow inpatient records for authorizations
Enter authorization in patient files in ECIN and EPIC systems.
Contact insurance companies to obtain the inpatient authorizations and send medical
records as needed
Facilitate and coordinate appeals of denied cases
Assist the nursing staff with any and all other clerical issues, and requests designated by
the department
Blue Cross Blue Shield of Michigan 04/16-03/19
Business Analyst
Research and resolve claim issues for Executive UAW Retirees
Serve as a departmental liaison between two health care providers
Research and provide answers to questions regarding benefits
Review claim status in NASCO
Provide administrative and technical support to assigned departments
Obtain missing documentation when necessary to convert claims to billable status by interacting and communicating with appropriate sources
Provide excellent communication/bedside manner to members of the plan
Verify member benefits, copays and deductibles to independently and accurately submit billable claims
Work collaboratively to achieve the goals of the group and the organization
Independently problem solves issues related to unpaid or denied claims
Maintains records to ensure accurate tracking of problem cases
AllState Insurance 06/15-04/16
Customer Service Benefit Specialist
Provide timely accurate information on policy activity
Answer routine insurance questions, such as status of accounts, billing and coverage; in most cases during the initial phone call
Actively listen to customer problems or questions, showing interest and compassion
Analyze and sort information given to determine the appropriate resolution
Exhibit the flexibility necessary to ensure customer focused quality
LACC CHILD CARE ACADEMY 03/15-6/15
Secretary
Developed a process for billing and managing tuition
Collect tuition payments
Enroll students and complete the enrollment process
Improved workflow processes and procedures
Address any child concerns with parent/guardian
Monitor and supervise children keeping them safe and healthy
Watch for any signs of behavioral or emotional problems in children and alert Senior staff and discuss with parents
Kept records of children’s routines throughout the day
Created schedules to ensure children have adequate physical activity, rest, food and intellectual stimulation
Assist with daily activities and personal care
Blue Cross Blue Shield of Michigan 08/13-08/14
Product Development Analyst
Managed and monitored the life cycle of multiple projects simultaneously according to project plans, objectives and budget.
Served as a departmental representative as needed for intra-departmental meetings, gathering key information to effectively improve operations of the team.
Improved workflow processes and procedures over time, improving internal and external customer service, as well as minimizing company cost.
Communicated company standards and procedures to employee population while monitoring continuous compliance.
Compliance Technician 02/12-08/13
Verified benefit coverage and notified medical professionals on various levels of appeals, as necessary.
Researched and analyzed departmental compliance data to drive sound business decision-making regarding new products and programs.
Completed compliance reviews regularly, ensuring that the Compliance Team members properly documented data and followed proper protocol.
Determined the root cause of inconsistent data points, working to resolve problem areas in a timely, efficient manner.
Business Analyst 11/12-02/13
Facilitated process analysis and modeling, requirements analysis and documentation, workflow, and performance (productivity and quality) measurement.
Performed iin-depth research analysis, identifying trends and common issues, recommending best practices to ensure maximum performance.
Supported client clinical and non-clinical departments to effectively resolve problems and improve standard operating procedures.
Develop and analyze quarterly performance reports for quality forecasting.
Midwest Health Plan 03/11-09/11
Denials & Appeals Coordinator
Performed complex compliance research and regulatory analysis to ensure consistency with group and product guidelines to remain compliant with NCQA standards
Researched cases and prepared presentations for administrative law judge hearings, as well as present case before the administrative law judge
Prepared and took department through NCQA Accreditation
Managed the overall evaluation establishment and implementation of new and improved workflows processes, reporting systems and new products.
Processed client appeals and billing according to the National Committee for Quality Assurance (NCQA) standards.
Quest Diagnostics 02/04-11/10
Pathology Medical Transcriptionist
Performed accurate transcription of all specimens received in the Pathology department, adhering to established productivity and quality standards.
Distributed detail-oriented transcribed reports to medical professionals, when required.
Acknowledged and investigated areas of concern, taking immediate corrective action to maximize efficiency of the department.
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