Front Desk Office

NANCY SPRAY 514-***-**** ************@*****.*** Tempe, AZ

BENEFITS SPECIALIST HEALTHCARE ADMINISTRATOR

Benefits administrator with a strong foundation in healthcare industry benefits administration, Medicaid enrollment validation, practice management, and 10 years of experience working with a low income population in addition to 15 years of advisory experience influencing positive changes in patient services. Brings a track record of up to 45% revenue growth and improved cash flow in most recent role as a Tribal/First Nations healthcare administrator. Recently relocated from Oregon and seeking a role in the Valley. Provider Credentialing Medicaid Eligibility Verification Enrollment Validation Tribal Healthcare Benefits Experience CORE COMPETENCIES

HIPAA Compliance Standards Customer Service Principles Medicaid Benefits Eligibility Requirements File Management Accurate Data Entry Timely Record-Keeping Benefits Administration Practices Benefits Research & Analysis MS Office / Tech Savvy Community Outreach Retrieving Database Information Time Management Additional Qualifications: Managing Multiple Projects / Project Management, Reliable, Strong Verbal and Written Communication Skills, Self- Starter, Interpersonal Skills, Working with Minimal Supervision, Discretion, Sound Judgment, Confidentiality, Patient & Persuasive Financial & Business Acumen: A/R, A/P, Billing and Invoicing, Insurance Verifications, Cash Flow Management, Revenue Cycle Management Software: Microsoft Office Suite (Excel, Word, PowerPoint), EHR Systems (Allscripts`, NextGen, Dentrix), Resource and Patient Management Systems (RPMS), Zoom, Teams

PROFESSIONAL HISTORY

Healthcare Administrator Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians 2014 – Mar 2021 Began in an administrative role in the dental clinic and gradually expanded scope to include revenue cycle, electronic billing, front desk workflow, process improvements, and purchase / referred care. Reported to the Medical Director and transformed profitability for an office with $700K in annual revenue/1K+ active patients, 50% of which receive Medicaid.

• Moved into purchased / referred care in 2016 and fully revised pharmacy guidelines to include alternate payers.

• Cross checked primary payers with secondary payers and government subsidized programs (Medicaid, Medicare, VA) to maximize revenue and profitability.

• Helped connect patients directly with pharmacy benefits programs, required use of insurance verification, and began tracking both eligibility and patient coverage at near 100%.

• Ceased payments of “roster billing” and produced $165K in savings.

• Initiated cross-checking with state Medicaid systems before appointments. Increased Medicaid collections 65% and properly classified formerly “uninsured” patients as Medicaid when appropriate. Rebilled back Medicaid services and recouped $45K.

• Advised the Medical Director on front desk operations at a 10-employee clinic treating up to 30 patients/day. Ran reports out of Dentrix and quickly realized that AR was operating at an average of 90 days. o Established a collections process and immediately rebilled commercial payers (collected nearly $40K) o Pursued payments from private accounts and self-pay patients with balances < 2 years old (recouped $15K)

• Set up an electronic billing process after seeing an opportunity to standardize turnaround and billing procedures. Instituted processes for Delta Dental, Pacific Source, and Moda Health – and added 25 new payers. Sped up turnaround by 3X to < 30 days. o Decreased AR older than 30 days to < 10%

• Employee of the Quarter, Q3, 2016. Certified annually as Marketplace Tribal Assister and Community Partner with Oregon’s Medicaid program and Guest of Honor at the Portland Area Director’s Recognition of Excellence ceremony as FOIA Team member. Patient Care Coordinator South Coast Orthopedic Associates 2007 – 2014 Hired as Referrals Coordinator for a high-volume, fast-paced environment with 6 practitioners who saw 180+ patients/day. Quickly transitioned into an Interim Manager role with responsibility for front desk, referrals, scheduling, prior authorizations, transcription, switchboard, payer relations, billing, invoicing, and collections. Effectively managed conflict by repairing the relationship between front desk and billing with monthly meetings and played a critical role in improving workplace morale. Accelerated scheduling for new patients 2-4 weeks by speeding up prior authorizations and rolled out cross-training, a key component behind the office transformation. Referral Coordinator Little Lakes Health Center (FQHC) 2005 – 2006 Managed all referrals, scheduling, and medical records for a medical clinic with 2.5K patients and $950K in annual revenue. Dental Manager Long Valley Health Center (FQHC) 2003 – 2005 Supervised 5 employees in the front and back office for a practice with 2 dentists and $850K in annual revenue. Drove 35% growth in revenue with new billing practices and actively resolved both collections and outstanding claims. Credited with the full customer service and operational turnaround of the practice.

EDUCATION

~2 Semesters at Mendocino Community College

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