Specialist Billing Operations Coordinator

CAROL J. MONYEH

***** ********* ***** 301-***-****

Silver Spring, MD 20906 ******@***.***

Qualification summary

Health Care Administrator with extensive and diverse managed care experience including but not limited to provider relations, member services, account/contract management, and utilization management. Enthusiastic, detail oriented team player with exceptional interpersonal communication skills and compassionate approach to customer concerns.

EXPERIENCE

Montgomery County Public School, Rockville MD 2015 to present

Security Monitor

Responsible for the operation of the Board of Education Master Alarm System (BOEMAS)

Coordinate security operations to insure that all Montgomery County Schools are protected.

Monitor various types of security alarms installed within school property

Respond to various alarms and dispatch patrol in a timely manner appropriately

HOLY CROSS HOSPITAL, Silver Spring, MD 2007-2019

Patient Registration- Operations Coordinator

Completes registration for patients who presents with symptoms in the Emergency Room in a timely manner for the nurse to do triage.

Completes bedside registration and capture demographic and insurance information to assist with the discharge process, informing patients regarding co pay and financial information.

Performs registration for Obstetrical and Gynecological patients and attach records from the fax server to same registration for the medical staff to have available at time of admission.

Perform quality control check on various reports to ensure accuracy of registration on various in and outpatient admissions and ambulatory visits.

Interview patients and update records for Medicare compliance

HOLY CROSS HOSPITAL, Silver Spring, MD 2019-present

Patient Registration-Data Integrity Specialist

Meets daily productivity goals of reviewing and removing 40-50 accounts per 8-hour shift

Responsible for working the Patient Access work queues by ensuring accounts are resolved correctly and worked to completion.

Identify and quantify trends by department, payer, colleague and establish weekly measure to communicate issues to the Patient Access Director and Trainer.

UNITED HEALTH CARE, Rockville MD 2007-2009

Account Manager

Successfully and seamlessly coordinated business relations between the Organization’s provider network and third party payers (customers).

Educated approximately 50 payers on contractual issues and revisions to contractual requirements as necessary.

Served as facilitator and mediator during discussions about polices/procedures, financial outcomes, and operational goals.

Responded to inquiries for policy and procedure clarification.

Resolved issues relating to complaints, grievances, and appeals.

Achieved and maintained high level of satisfaction and retention of business from third party payers.

UNITED HEALTH CARE, Rockville MD

Operations Coordinator-Pre Service Department 2006-2007

Conducted, investigated and researched administrative issues relating to HMO/PPO products, while reviewing and completing member’s request as instructed by the policy of United Health Care.

Completed clinical denials within the two-business day turn around time.

Conducted research related to verification, denials and approvals

Responded to Physician’s request for prior authorization in writing in a timely manner

Performed data entry for Radiology and Dental Medical request

Communicated with internal and external customers by phone to assist with administrative questions and concerns related to HMO/PPO products

UNITED BEHAVIORAL HEALTH, Rockville MD

Senior Care Management Team Assistant 2004-11/06

Successfully managed process that ensured timely patient access to behavioral health services based on urgency of the clinical situation, thus preventing symptom exacerbation and unnecessary health care costs.

Worked with clinical staff to authorize routine outpatient behavioral health treatment in a timely manner.

Obtained/scheduled behavioral health appointments for patients in crisis to ensure they received timely professional intervention to eliminate potential harm to themselves/others.

Developed and implemented a mentoring program for new hires responsible for performing administrative tasks, thereby reducing cost and need for external training.

Partnered with clinical staff to authorize patient transitions from acute inpatient to lower levels of care, thereby promoting continuity of care and reducing fragmentation of services.

Senior Operations Coordinator 2002-2004

Developed and implemented system for performing and monitoring impact of appointment access activities.

Assisted with formulating department’s policies and procedures, which resulted in the effective and smooth functioning of the department.

Created a database, which tracked the health plan member’s requests for urgent access to the health plan’s behavioral health specialists.

Produced quarterly reports for the management team, which reflected various utilization patterns by the health plan members.

Developed and implemented a training/education module geared specifically for new employees. This resulted in the effective training and enhancing the performance of the new employees.

Operations Coordinator 2001-2002

Reduced prevalence of non-authorizations for administrative reasons by educating members and providers on authorization requirements

Developed comprehensive reports on outcomes of projects and provided formats for audience.

Coordinated and arranged on-site training meetings with providers.

Advised members and providers of insurance authorization process.

Handled average of 75-80 calls per day.

CHILDREN’S NATIONAL MEDICAL CENTER, Washington, DC 1997-2001

Office Coordinator-Urology Department

Oversaw daily administrative activities in a hospital unit and improved efficiencies when opportunities were identified.

Managed daily operations of the Urology Department for two Urologists and five Attending Physicians.

Supervised operational support staff.

Evaluated and monitored daily operations of the Urology Department.

Performed Quality Assistance for office visit and surgical billing.

Scheduled surgical Urology procedures using the Operating Room Scheduling System (ORSOS).

EDUCATION

B.S., Healthcare Administration, University of Maryland, 1996

COMPUTER and OFFICE SKILLS

AS/400 Power point

Microsoft Word MS-DOS

Windows 5.0 Excel

HBOC-Surgical scheduling Medical Terminology Certificate

Therapist Helper-for mental Health Specialist billing

VOLUNTARY COMMUNITY SERVICE

PTA Board member (JFK High School)

Membership Recruiting

Responsible for membership drive and recruitment.

Child advocate and awareness of Parental involvement in PTA activities.

Parent Liaison, cultural diversity.

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