Processor Dialysis
Resume:
Frank Baldoni
*** **** ******** ****** ******** PA 18510
Objective
Education
McCann School of Business 2002 until 2003
Scranton High School Class of 2001
Employment
Quality Review and Audit 02.12.2020 – Present
• Audit New Hire Processors Training in Skills 1, 2, 3 and Medicare Claims for Accuracy.
• Provide Feedback to processors by Utilizing SOP’s, Checklists and Job Aids to Validate Accuracy of Claim processing per Cigna Policy and guidelines.
• Act as a Subject matter expert/resource for new hire processors to insure the processor learns from Mistakes make when processing.
• Work with auditing manager to escalate error trends for new hires. Cigna Quality Coach 06.2018- 02-12-2020
Answer Dialysis HCCU questions.
Coach Dialysis advocates as needed.
Track and Trend Dialysis Q&A.
Track and Trend Dialysis errors.
Work closely with Dialysis supervisor.
Network with account CSE.
Network with COB SME support team.
Access to CRT, Ringmaster and Sam3 Errors - handle when Dialysis supervisor is out Of office.
Cigna Health Care 10.05.2009 – 06.2018
• Point of contact when our manager is out.
• Report inventory numbers daily and managed inventory assignments when needed.
• Managed Texas LPI ASO and NON ASO Report daily including Follow ups.
• Processing of claims on the proclaim platform using Xnet, IView, ICMS, BA, GROUP, CED, One View, the Visium tool, Excel and SOP’s related to the processing of Dialysis claims.
• Proficient at looking and interpreting MOS tools and have done barrier calls
• Have good communications skills both written and verbal.
• Proficient in Proclaim and have some experience in Facets platforms.
• Proficient in Lync, Excel, Word and Power point.
• MRC1/MRC2 Trained working in Citrix platform
• Trained in the PRF platform.
• Medicare Estimations.
• Behavioral Health claims.
• Support QC
• I have worked dedicated accounts and Members.
• Helped Test all functions of Corkboard to insure the system is working correctly after updates. TMG Health 01.012007-10.05.2009 Enrollment Supervisor
• Supervised over 20 processors and 2 team leads.
• Responsible for individual plan enrollments and disenrollment’s.
• Responsible for one on ones and year end reviews.
• Responsible for payroll and approving time sheets. And paid time off.
• Preformed reporting for internal and external customers daily.
• Approved letter templates for internal and external communications.
• Communicated with clients Quality department to insure client specifics were met regarding the percentage of enrollments checked and that the QC team has up to date SOP’s for correct auditing.
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