Managed Care Data Entry
Resume:
BERYL JONES
ST. PETERSBURG, FLA
*********@*****.***
Enthusiastic hard working employee. Driven at whatever assignment or duty given. I am a passionate team player, I have a customer service background, I enjoy helping others, I also strongly believe in accuracy and integrity.
SKILLS
Very computer literate,Data Entry, 10 Key,transferring files and presentations. Office skills to include an excellent phone etiquette
EXPERIENCE
DR, SYED K. ZAIDI, MD
Front end Office Specialist
APRIL 2021 - JAN 2022
TELECOMMUNICATIONS SPECIALIST
. Inbound service calls, various duties to include follow up to ensure customer satisfaction, job completion and resale.
MARCH 2005 – MARCH 2020
PROVIDER ENROLLMENT AND CONTRACTING ANALYST, NATIONAL JEWISH HEALTH HOSPITAL, DENVER, CO
●Managed provider enrollment payor contracts between hospital, physicians and payors
●Led and coordinated managed care contract negotiations by reviewing contract language and determining hospital participation
●Coordinated hospital and practitioner application process
●Submitted all applications to managed care plans on behalf of hospital
●Maintained managed care and physician database and contract terms and government requirements
●Maintained managed care websites in partnership with webmaster
●Developed internal operating reports to quantify portfolio performance
●Performed research and documented customer information regarding current status, payment expectations, notes of conversations and other relevant information on various computer systems
FEBRUARY 2004– FEBRUARY 2005
MEDICAL EDUCATION REPRESENTATIVE, SCHRYVER MEDICAL INC (NOW TRIDENTCARE)
●Led education efforts of all employees for annual Medicare certification programs
●Served as compliance officer for all Schryver Medical business affairs
●Prepared and submitted monthly reports to internal management on status of outstanding medical bills and proposed/planned payment settlement details
DECEMBER 1999 – FEBRUARY 2004
MEDICARE PTB EDUCATION REPRESENTATIVE, BLUE CROSS BLUE SHIELD
OF NORTH DAKOTA
●Served a Medicare Part B educator for the states of Colorado and Wyoming
●Performed Medicare audits per governmental regulations and protocols
●Trained practitioners and medical billers on how to successfully bill Medicare Parts A and B
●Managed payment resolution with third party payors
●Trained employees on Medicare compliance per Centers for Medicare and Medicaid (CMS) guidelines
EDUCATION
MASTER OF SCIENCE, TEXAS SOUTHERN UNIVERSITY, HOUSTON, TX
Major: Public Relations
BACHELOR OF ARTS, CLARK COLLEGE, ATLANTA, GA
Major: Business Management/ Human Resources
CERTIFIED MANAGED CARE ENROLLMENT ANALYST
Blue Cross Blue Shield of North Dakota
CERTIFIED MEDICAL ANALYST
Blue Cross Blue Shield of North Dakota
ADVANCED SKILLS
●Expert knowledge of Medicare Parts A, B and C
●Practitioner Educator
●Certified speaker and trainer
●Medicare operations and standards
●Compliance analysis
●Durable medical equipment (DME)
●Managed care
ACHIEVEMENTS
●Medicare Education Representative for the states of Colorado and Wyoming
●2004-Award Speaker, Podiatric Society
●2005-Certified Coder, Rocky Mountain Billing and Coding
Contact this candidate