Jessica Riano

ad3180@r.postjobfree.com 646-***-**** Charlotte, North Carolina, 28216

PROFESSIONAL SUMMARY:

Experience with professional administration experience with Microsoft Office Word, Outlook, Excel, PowerPoint, ECW, MediTract and EMR-Epic.

Excellent verbal communication

Research and data analysis

Office management professional

Deadline-driven.

Data and Project implementation and management

Experience with provider relations and in healthcare.

Able to read, write and communicate in Spanish.

EDUCATION:

09/2019-PRESENT SOUTH NEW HAMPSHIRE UNIVERSITY B.A HEALTH SERVICES ADMINISTRATION

EXPECTED GRADUATION MAY 2024

EXPERIENCE:

One Brooklyn Health

Brookdale Hospital Medical Center, Kingsbrook Jewish Medical Center, Interfaith Medical Center

Manager, Managed Care Contracting 09/2019-Present.

Managed Care Contracting Dept.

Assist the Senior Director by serving as liaison between Managed Care Organizations and OBH staff in the coordination of the delivery of high-quality services and contracting opportunities, resolving billing and reimbursement accuracy.

Interpret Managed Care Agreements and work with EPIC IT to implement the contracts into billing system (EPIC) with payer codes, rates, new line of business and new payor names for both hospital and physician billing.

Initiate provider enrollment through facility credentialing for each new contract, distribute all current provider licenses, certifications, operating certificates, Professional Liability, and any other supporting documentation for all three campuses. Track re-credentialing every 3 years when payors are due.

Negotiate single case agreements for our out of network payors.

Facilitate all JOC meetings with contracted payors, Revenue Cycle dept. and Patient Financial Services dept. Follow up on all open items. Distribute meeting minutes, agendas. Follow up with open items.

Assist Revenue Cycle department with collection of Accounts Receivables, through evaluation of denials and claims and appeals.

Track, distribute and interpret all new Managed Care agreements to internal departments for all three facilities, clinics, and skilled nursing facilities. Create contract matrix reflecting reimbursement, and contractual terms.

Track, upload, and maintain of all Managed Care contracts in our data system Medi Tract.

Assist in special projects as per CFO’s requests.

Visiting Nurse Service of New York

Associate Account Manager 5/2018-08/2019

Administrative Coordinator 3/2018-5/2018

Managed Care Contracting Dept.

Serve as a liaison between Managed Care companies and VNSNY staff in communication of new agreements/amendments

Participate in developing and implementing strategies for improving the efficiency and effectiveness of the managed care agreements and care.

Manage the reporting and assesses the results and status of the payers on an ongoing basis to achieve VNSNY goals.

Assist Revenue Cycle department with collection of Accounts Receivables, through evaluation of denials and claims

Interpret contracts to managed care payers and with VNSNY internal staff.

Initiate provider enrollment through credentialing for each new plan; distribute all current provider licenses and certifications.

Assist with all communication of negotiation and re-negotiation of all contracts internally and externally.

Ensure client satisfaction through constant professional communication via phone, email mail and in person meetings.

Identifies work processes and workflow changes, organizational impact, and training requirements of new/enhanced automated systems, contracting renegotiations to ensure effective implementation.

Assist Director to prepare, present and monitor all necessary reports to effectively evaluate payer account status; as well as identifying new contracting opportunities

Work independently in handling internal/external client situations by utilizing effective problem solving skills, addressing client concerns, providing thorough follow-through, and in all cases consistently providing excellent customer service.

Keeps current with changes and rates in the managed care marketplace, CMS, and DOH to ensure products and services are competitive and meet client needs

Visiting Nurse Service of New York 5/2016-05/2018

Administrative Coordinator for:

CMO of Provider Services, Sr.VP of Strategy, VP of Quality, and Director of ESPRIT Medical Care PC

Research, organize and assist the Chief Medical Officer with various projects pertaining to new programs in VNSNY

Assist the Ethics Committee with projects, trainings and case intakes

Coordinate/maintain Chief Medical Officer and the Senior Vice President calendars, conference calls, meetings, travel arrangements and events

Assist with onboarding process for new employees; act as a liaison with IT dept. and Human Recourses dept.

Review and upkeep all policies and procedures for ESPRIT Medical Care PC program

Register all new vendors into our ASPEN system for payment

Process and track invoices, create all check requests, pay vendors and maintain communication with Accounts Payable

Create purchase orders for all new vendors

Complete and update Wage Parity attestations and distribute to all Managed Care payers

Gather acquired documents for completion of credentialing applications for payers in contracted CHHA, Partners, Hospice and Article 31 FRIENDS Clinic. for Managed Care dept.

Maintain and track all incoming medical records requests between the Legal Dept. and Managed Care Dept.

Interview, hire, train and onboard interns and volunteers; supervise and delegate tasks accordingly

Answer and screen phone calls, route and take messages

Act a liaison between vendors and executive managers

Amex reconciliation for the Chief Medical Officer and for the Senior Vice President

Credential and re-credential all licensed clinical social workers pertaining to the Behavioral Health Community Transitions program through CAQH

Track and maintain all updated licenses for all providers

Process all reimbursements for leadership managers

Control all inventory and order office supplies as needed

Draft materials for presentations, reports, publications and distribution

Visiting Nurse Service of New York 5/2013-05/2016

Behavioral Transitions Program

Program Assistant

Assist the Program Coordinator with scheduling of patients and social workers for follow up appointments with patients being discharged from psychiatric and substance abuse units

Check insurance eligibility on each referred patient before the referral is accepted

Check insurance eligibility for all patients being followed by program (approx. 400) 3 times monthly

Maintain/Process all clinical assessments received from clinicians

Assign all new referrals from multiple insurance companies to appropriate social worker

Daily communication with hospital facilities; insurance companies, billing department and oversight company

Assist the Program Coordinator with recommendations for hiring and participating in the interview process and screening of new clinicians

Registering all new patients into the electronic medical record system

Responsible for all HIPPA violation codes; discretion with patient information/confidential correspondence/all patient inquiries

Interpret client-related program data

Attend monthly meetings with Program Coordinator and Associate Director to present/discuss patient outcomes of program to all health plans.

Assist Program Coordinator with development of program presentations through PowerPoint screenings; pamphlets; hand-outs

Daily contact with clinicians about patient notes, due dates and health plan updates

Set up, train and supervise administration staff; implement/delegate daily task responsibilities

Cantor Fitzgerald & Co. 8/2012-3/2013

Legal Administrative Assistant.

Assisted attorneys with non-routine tasks with personal judgment and resources, acted as a liaison between executive managers and attorneys.

Monitored multiple phone lines in a fast-paced and high pressured environment.

Interacted/Greeted high level managers and staff in an effective and professional manner.

Performed legal editing on confidential documents and employee/broker agreements.

Followed up with unexecuted agreements; prepared all executed agreements for electronic filing and distributed to appropriate parties.

Coordinated/maintained attorneys’ conference calls, calendars, meetings and events; prepared, filtered and distributed correspondence and letters.

Helped set up newly hired assistants and paralegals.

Responsible for office maintenance-ordering supplies, up keeping of all floor machines; printers, scanners.

Prepared packages for new hired brokers. Prioritized high volume, time sensitive and confidential tasks in a professional efficiently manner.

Prepared expense reports; maintained/processed all CLE requirements.

Processed all necessary check requests; Data store, Hummingbird and Work share experienced.

Bronstein Properties, LLC. 5/2011-5/2012

Administrative Assistant.

Assisted six property managers in day by day activity for rentals such as creating work orders for tenants to sign off. Creating purchase orders for vendors; maintained court dates on calendar. Tracked extermination services for all buildings; including all bedbug service requests. Ordered dust wipes for required apartments.

Ordered appliances for all buildings through purchase order system; called & scheduled repair services for appliances; Maintained painters’ schedules along with payroll.

Ordered phones for company employees and superintendents.

Tracked company’s cell phone bills.

Tracked water usage in each building on a monthly basis through AMR.

Tracked all sanitation tickets/violations; tracked all fire department permits, made sure all were up to date.

Tracked all boiler cleanings for all buildings.

Heavy communication with tenants sent out certified notices to tenants; arranged access for repairs.

E-certified all HPD violations; RSA Annual registrations; MDR Annual registrations; follow up & preparation on Bank/Insurance Recommendations.

Prepare all documentation for F-TAP program on buildings; MRI experienced.

All Area Realty Services, Inc. 8/2010-4/2011

Assistant Property Manager

Provided high-level administrative support to Property Manager

Assisted in managing 9 properties

Prepared needed documents and reports for board meetings

Heavy communication with board members through emailing and phone

Contacted superintendents on daily basis for work done at sites

Took all incoming calls and complaints about maintenance issues

Obtained proposals from multiple vendors

Tracked residents/shareholders activity through management’s system Yardi

Coordinated with residents for move in/move out procedures

Acted as liaison and maintained open lines of communication with senior executives, board members, middle management and administrative staff.

Criterion, Astoria, NY 5/2009-7/2010

Receptionist/Administrative Assistant

Support management with day to day activity including communication with residential tenants, contractors, and real estate brokers

Assisted with reception, screened all calls for Principals of company

Arranged meetings and prepared meeting minutes

General office management, supplies, schedules and day to day office duties

Enter and regulated rental payments on residential management system (RIS)

Leasing – Meeting potential renters, conducting tours and apartment walkthroughs with prospective tenants, approving tenants, negotiating leasing terms, creating apartments leases, maintaining lease records, and negotiating tenant renewals

Obtained proposals from multiple vendors

Created highly effective organizational and filing systems including quick and thorough indexing, filing off-site storage, resulting in easy access to critical information and streamlined office functioning.

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