Nisreen Abbosh

***** ******** *** ********** *****, MI 48336 adv377@r.postjobfree.com 248-***-****

I am looking for a challenging position as an administrative professional where I can apply my experience and education in the healthcare system.

Area Of Expertise

Negotiated HRSA, Medicaid, HMO, Hospital, PHO, ACO Contacts

Established a non-profit organization, contracted facilities with hospitals and healthcare organizations

Negotiated provider contracts

Finalized Hospital along with facilities to work as urgent care providing after hours services

Analyzed demographics to gain knowledge in provider the needed level of care and services

Worked with non-profit organization to gain finances to assist underserved community with providing medical services to increase quality medical care

Negotiated Government contracts to offer medical services to the noninsured and underinsured

Facility Credentialing

Provider Credentialing

Knowledge of CAQH, NPPES, BCBSM EDI TPA online application, CHAMPS (Medicaid enrollment), CMS and PECOS (Medicare enrollment) and third-party payor applications

Knowledge of provider credentialing and its direct impact on the practice's revenue cycle

Strong knowledge of ECHO, CAQH, PECOS, NPPES, and CMS databases required

Proficient computer skills to include MS Office, MS Excel, MS Word, MS Outlook, Adobe Pro, MS Access

Experienced with RHC credentialing

Audit chart and billing

Educate physicians and staff on Medicare and Medicaid rules and regulations

Review physicians' chart and documentation

Educate Physicians proper coding for the appropriate level of visit

Educate physicians on the rules related to fraud, waste and abuse

Educate physicians and staff on the rules related to kickback Physician

Credentialing

HEDIS measures

Human resources

Physician recruiting

Physician contract negotiation

Proficient in ICD-10/CPT codes

Perform regular chart audits to meet billing criteria

Educate physicians and staff on new billing standards and codes HIPAA rules and regulations

Familiar with most Microsoft office programs

Bilingual Arabic and English language

Experience

McLaren Health Plan

Responsible for routine operations within the credentialing department.

Distribution of tasks. Responsible for assisting manager and handling all or most issues.

Assumes primary responsibility for archival, retrieval and distribution of Department documents and reports.

Respond to internal and external customer inquiries regarding credentialing status.

Process, track and file credentialing applications within established standards.

Maintain and update credentialing database.

Identifies, troubleshoots, and resolves issues related to credentialing, privileging and on-boarding of medical staff providers.

Perform quality review audits of credentialing files.

Meet or exceed departmental timeframes and quality metrics on a consistent basis.

Develops, manages and monitors processes and procedures that support the credentialing, re-credentialing, and delegated credentialing contract processes.

Maintain ongoing communication with health plan representatives, contracted providers and hospital departments.

Perform follow-up and complete requests, as necessary.

Business partner/ Office manager, Advanced Medical Care Clinic. Dearborn MI 2017-Present

Growing the business

Manage referrals and provide consistent quality care.

Managing the team Teach "hands on" techniques by reviewing cases and role playing.

Manage the budget Payroll, distribute quarterly bonus', purchase of office supplies and equipment.

Prepared quarterly reports to follow up on HEDIS measures.

Responsible for submitting ICD10/CPT codes to meet HEADIS measures, educated new. and existing physicians to ensure the facility is up to date with the required HEADIS measures.

Communicated with third party for proper submission utilizing billing or other software.

Hiring Interview, hire and train new staff to construct a skilled and competent clinical team.

Human resources Addressing employee concerns, handling weekly schedules, payroll, and training.

Credentialing.

Responsible for all credentialing of new physician hiring.

Medical Office & Billing Dept. Manager, Family Care Medical Center, Detroit MI 1999 to 2017

Increase clinical revenue Reduce patient wait time to increase patient satisfaction. This also increased the number of patients and thus revenue increased also. Implemented the use of CLIA waived tests used to expedite patient diagnosis.

Weekly analysis of clinic profitability Monitor weekly analysis to alert management to revenue changes.

Responsible for increasing revenue by monitoring HEDIS measures by improving the compliance level and increasing HEDIS measures, I reached the desired benchmark to collect the incentives along with yearly bonuses.

Implement strategies to improve daily operations of medical practice Implement new billing, EMR/EHR software to maintain compliance with ICD10 codes and collect government incentives.

Serve as liaison between patients, doctors, insurance providers and other healthcare associates Attend third party seminars, collect educational material for staff members to maintain HEDIS, HIPPA, OSHA, and insurance requirements to maintain compliance.

Responsible for submitting ICD10/CPT codes to meet HEADIS measures, educated new and existing physicians to ensure the facility is up to date with the required HEADIS measures.

Communicated with third party for proper submission utilizing billing or other software.

Investigate and document billing errors.

Consult with physicians for accurate billing using ICD-10 and CPT codes.

Consult legal specialist to establish appropriate billing

Assist in state and insurance audits Participated in state run audit, answered all billing and compliance questions.

Attend state seminars to meet state and Medicare compliance rules Attend State seminars that are focused on fraud and abuse to help minimize errors to prevent insurance audits.

Responsible for full cycle recruitment including sourcing, interviewing, and hiring medical professionals Responsible for maintaining full staff that consist of medical assistance, doctors and other healthcare professionals. Contracted with HERSA (Health Resource and Service Administration) to utilize their MIMOS (Michigan Medical Opportunity) program to locate specialty specific doctors and mid-level doctors.

Manage medical vendors.

Resolve all medical staff/physician issues to maintain workflows · Conduct market research for grant.

Manage team of physicians, MA’s and practice managers to improve daily operations Lead a team of physicians, medical assistance, and mid-level physicians and other professional employees to increase patient satisfaction.

Monitor HIPPA laws, policies and procedures to meet compliance in ensuring patient confidentiality, I produced HIPPA rules and regulations that are clinic specific to educate and store in staff personal folder.

Medical Office & billing Dept, Springwell's Clinic, 2117 Springwell's Detroit MI

Hire, train and manage office staff.

Follow up on all postings and rejections.

Generate doctor and medical staff work schedules.

Negotiate and resolve all patient inquiries and issues.

Responsible for ordering and maintaining vaccine and office supplies DMC. PHO (Physician Hospital Organization), internship.

Develop quality assurance plan.

Validate and maintain quality measures.

Educate physicians and staff to help maintain high quality measures.

Baker College, MBA/Health Care Management, 2014

Walsh College of Accountancy, BBA 2005 Oakland Community

College, Associates degree in General Business 2003

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