Data Entry Governance
Resume:
John Abram
Pittsburgh Pennsylvania 15201
*********@*****.***
Objective: Utilize my skills and experience to advance my career in a dynamic and growing organization.
EXPERIENCE:
ADAPT PCS / MCKESSON
Payor Support
November 2016 - Present
Proactively contacted payers for fee schedule and coding updates and addressed inquiries as needed.
Collaborated with the Credentialing Team to facilitate new contracts and changes to existing contracts.
Resolved pricing discrepancies by communicating effectively with payers.
Assisted in resolving claim issues with payors, working closely with billing and other departments.
Contributed to provider agreement negotiations with health plans as part of the Payer Engagement Team.
Maintained the Master Contracting Log.
Essential Functions and Job Responsibilities:
Assisted in aligning the system with reference tools.
Conducted research on Payer contracts, manuals, and policies to provide guidance and answers on specific topics related to guidelines.
Supported the Compliance team in the interpretation of Medicaid guidelines for operationalization.
Collaborated with the system configuration team to ensure alignment and compliance with payer guidelines.
Aided in communicating payer update notifications to the business.
Updated and maintained the Payer Reference Tool.
Facilitated the transfer of new payer data from the contract department to appropriate teams.
Completed Jira requests for inquiries and maintained an SLA on response time.
Effectively communicated with the business regarding assignments and projects.
Managed data governance for existing payers to validate that the system had the most updated information based on a cadence.
Maintained patient confidentiality and functioned within the guidelines of HIPAA.
Completed assigned compliance training and other educational programs as required.
Maintained compliance with AdaptHealth's Compliance Program.
Performed other related duties as requested or assigned.
Essential Functions and Job Responsibilities:
Assisted in aligning the system with reference tools.
Conducted research on Payer contracts, manuals, and policies to provide guidance and answers on specific topics related to guidelines.
Supported the Compliance team in the interpretation of Medicaid guidelines for operationalization.
Collaborated with the system configuration team to ensure alignment and compliance with payer guidelines.
Aided in communicating payer update notifications to the business.
Updated and maintained the Payer Reference Tool.
Facilitated the transfer of new payer data from the contract department to appropriate teams.
Completed Jira requests for inquiries and maintained an SLA on response time.
Effectively communicated with the business regarding assignments and projects.
Managed data governance for existing payers to validate that the system had the most updated information based on a cadence.
Maintained patient confidentiality and functioned within the guidelines of HIPAA.
Completed assigned compliance training and other educational programs as required.
Maintained compliance with AdaptHealth's Compliance Program.
Performed other related duties as requested or assigned.
Customer Service
Provided patients with comprehensive information and assistance related to medical supplies.
Specialized in various medical product categories, including Wound Care, Ostomy, Diabetic, and Incontinence.
Conducted insurance-related tasks, including data entry and insurance claims support.
Prospector’s Group/Vitus Holdings
Insurance Prospecting Sales
October 2004 to August 2011
Pittsburgh, PA
Conducted data entry tasks efficiently.
Prospected potential clients in need of insurance for their businesses.
Provided computer repair services when necessary.
Trained and advised employees in the Sandler Sales System.
Stat Staffing Medical Services
Medical Assistant
February 2001 to June 2006
Pittsburgh, PA
Administered injections and performed phlebotomy services, including blood draws.
Recorded vital signs accurately.
Assisted in bone marrow biopsy extractions.
Ensured thorough investigation and verification of insurance authorizations and referrals.
Supported clerical tasks, including typing and filing.
MILITARY EXPERIENCE
US NAVY – BOATSWAIN MATE – 1989-91
Demonstrated exceptional responsibility in caring for the ship, steering mechanisms, engines, and security watches.
Successfully steered the naval tender, the USS Samuel Gompers.
Acquired on-the-job training as a hospital corpsman.
Operated underway replenishment cranes efficiently.
EDUCATION
COMMUNITY COLLEGE OF ALLEGHENY COUNTY
Pittsburgh, PA
2000 to 2002
Major: Computer Information Technology
Western School of Health and Business
Pittsburgh, PA
August 14, 1994
Degree: Associates in Medical Assisting
SKILLS
Proficient in Microsoft applications, including Word, Excel, Access, Explorer, and Outlook.
American Red Cross certified in adult and child CPR.
Holds a valid PA driver’s license with CDL Class A and Tanker Endorsement.
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