Implementation/Project Manager/Customer Service

RAINER JOHNSON

**** ******* ***** **** ********* Fl 32526 • adncrt@r.postjobfree.com 850-***-****

Experience

Skilled professional with varied and practicable healthcare experience, providing reliable reporting, customer service, technical and administrative support within various health clinics and offices. Display superior dedication and commitment in Full-Cycle Implementation, Revenue Cycle Management, Administrative Training and Education in Healthcare Systems and Technical Support.

Skills

oSupervisory/Managerial

oTraining Coordinator/Project Manager

oAllscripts Practice Management Administrator Subject Matter Expert

oPhreesia Administrator

oHIPPA Compliance Training

oEPIC

oAllscripts

oPhreesia

oAS-400

oMicrosoft Office 365

oWindows Applications

oInspro

oCase 360

oPractice Partner

Professional Experience

GLOBALHEALTH HOLDINGS

ENROLLMENT SPECIALIST 05/2021 - CURRENT

Verifies enrollment status, makes changes to records, research and resolves enrollment system rejections.

Ensures accuracy and timeliness of membership and billing function.

Determine eligibility and perform error output resolution processing error lists, bills and reconcile payments in EPIC.

Review and process daily and weekly enrollment files.

Provide Customer Service by contacting members for enrollment and eligibility issues.

OPTUM / UNITED HEALTH GROUP ( thru Randstadt) 09/2020 thru 02/2021

IMPLEMENTATION CONSULTANT

Created, audited, implemented and published provider schedules in Allscripts Practice Management System Project providing support over 500 providers and clinics.

Develop system requirements, build, test, and deploy implementations.

Collaborate with project team supporting configuration, execution and planning of provider scheduling templates meeting projected deadlines.

Provide technical support in Full-Cycle Allscripts provide schedule deployment implementation in test and live environments.

Assisted with post implementation contacting providers and staff telephonically and through email.

Communicated with providers and clinical staff addressing system concerns and resolving issues.

Entered facility and provider information into APM required for scheduling and billing template.

Merge duplicate patient accounts in APM and Touchworks.

Strong APM configuration skills

Assists with APM scheduling builds

CAPGEMINI 04/2018 – 08/2020

ELIGILIBLITY SPECIALIST Pensacola Florida

Examine Benefit Eligibility Requirements to submit to Continental Group Insurance for new and existing policy holders to determine eligibility and benefits of each individual policy.

Responsible for training oncoming and present employees regarding policy and eligibility changes and requirements

Contact Physician Offices, Skilled Nursing and Assisted Living Facilities as needed to obtain annual medical forms such as Medical Attestation Forms, Tax Qualified Addendums, Medical Records.

Review medical records to determine insureds’ placement for Skilled Nursing, Assisted Living and Home Health Care.

Notify and submit benefit exhaust documents, Waiver of Premiums, Refund/overpaid documents as needed.

Communicated with providers and clinical staff addressing system concerns and resolving issues from Customer Service Complaints with insureds.

Audit and prepare eligibility reports.

Escambia Community Clinics, LLC 03/2015 – 03/2018

Allscripts Practice Management Administrator Project Manager

Project Manager responsible for application and interface support and configuration of Allscripts Practice Management, EHR and FMH Patient Portal for 15 FQHC Health Clinics to include Dental, Family Practice, Optometry, OB/GYN, Urgent Care and Pediatric Sites, System Administrator for Phreesia.

Assists with APM scheduling builds, developed requirements, build, test, and deploy product implementations.

Independently managed product enhancements, including defining new enhancement requirements and feature with the application vendor.

Participate in vision session for the development of product enhancements for clinical and administrative staff.

Analyze and provide feedback regarding billing operations, front desk staff duties and financial reports.

Performed troubleshooting functions for Allscripts and Phreesia Software.

Communicated with existing and potential clients providing demonstrations on systems for local and national Healthcare Facilities upon client requests.

Monitor progress and production of employees from initial phase of Revenue Cycle Implementation to final phase ensuring all medical and dental claims are processed and complete through clearinghouse.

Responsible for application and interface support of Allscripts Practice Management, EHR, and FMH Patient Portal.

Built provider profiles, provider schedules, and updated and built provider schedules.

Led RCM Project upon Allscripts Billing Implementation.

Developed onboarding and IT Training Programs for Front Desk, Clinical and Physicians utilizing APM/EHR, FMH and Phreesia.

Support of HIPAA Security and Compliance, Health Data reporting and development of new workflows to comply with FQHC Regulations including training of health center staff.

Assist consultants with interfacing and GO-LIVE onsite for 17 sites.

Subject Matter Expert in training for individual and group sessions remotely and onsite for APM/EHR/Phreesia Utilization.

Monitored medical claims processed through Clearing House to ensure proper submission.

IGATE – Pensacola FL

PROJECT MANAGER, SYSTEMS OPERATIONS 01/2013-03/2015

Led 15 employees processing Humana/Medicare Claims.

Established and developed A/R Billing Workflows to ensure proper reimbursement, coding and submission maintaining an average A/R of 29 days.

Monitor production providing feedback to employees for improvement.

Named Project Manager for Humana Medicare Claims ensuring all deadlines are met for each phase.

Monitored medical claims processed through Clearing House to ensure proper submission

Distribute Denial Report to staff for completion.

Conduct semi-annual and annual Performance Reviews.

Responsible for six-month A/R Cleanup Project upon hire, accomplishing A/R 29 day.

MEDPRO SOLUTIONS, - Pensacola, FL 03/2012 – 01/2013

CLAIMS RESEARCH PROJECT/IMPLEMENTATION MANAGER

Responsible for the training and supervision of 17 employees.

Coordinate with physician offices and outpatient clinics for proper CPT and ICD-9 Guidelines.

Led Medicare Appeals Projecting resulting in over 1.3-million-dollar reimbursement.

Perform audit on various accounts at random for all insurance carriers – Commercial, Automobile, Military and Workman’s Compensation.

Developed IT Training programs for Clinical and Administrative Staff.

Monitored medical claims processed through Clearing House to ensure proper submission.

Conduct annual Performance Appraisals for 17 employees.

Developed Policy and Procedure for Claims Research Department.

Conducted weekly staff meetings.

SACRED HEART HEALTH SYSTEM - 04/1998 -03/ 2012

PATIENT ACCOUNT SPECIALIST/DIAGNOSTIC SCHEDULER/MEDICAL OFFICE SECRETARY

Transmit bills to carriers authorized to submit claims electronically or hard copy review non-electronic claims to ensure "clean" claims are submitted.

Review all Explanation of Benefits and Remittance advices received and take all necessary steps to ensure payments are accurate.

Check patients in for appointments, schedule follow up appointments, answer incoming calls.

Ensure proper ICD-10 and CPT Guidelines are followed.

Maintain medical records for patient assigned to office.

Schedule diagnostic testing for requesting offices.

Ensure proper diagnosis for testing and insurance eligibility and authorization.

Assist Billing Manager with Allscripts GO-LIVE and train coworkers on Practice Management System in the Sacred Heart Medical Group Billing Department.

EDUCATION

Associates Degree – Medical Transcription

KAPLAN UNIVERSITY

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