Data Entry Costumer Service

Anna Reydman

*** ******** ******, ****** ******, NY

718-***-****; E-mail: **********@*****.***

QUALIFICATIONS: Masters of Public Administration with 10 years’ experience in Health Care field working with chronic illnesses and psychiatric diagnosis/mental disability, substance abuse, HIV/AIDS and homeless population. Knowledge of psychiatric diagnoses, behavioral health management, governmental and federal benefits: Medicare/ Medicaid Long Term Care and MLTC insurances, DOH, Department of aging and DOHMH rules and Public Health Law. Experience in Utilization, Case/Care Management and Network Operations Management, Knowledge of Quality Improvement and Quality Assurance, HEDIS. Superior communication, management and administrative skills. Ability to communicate effectively with executives, patients, and staff

Brooklyn Health Home, Maimonides Medical Center, Brooklyn, NY 11/2016-present

Quality Performance Manager

Provides oversight to the performance evaluation process to promote the quality of the BHH program

Evaluates the needs of the clients with mental disability, chronic illnesses, substance abuse, coordinates patient services with internal and external service providers through regular case conferencing and extensive outreaching

Oversees program training, workflows, creation and updating of departmental training tools and resources to support the delivery of high quality, efficient care management.

Audits care management documentation, provides direct feedback and coaching to staff on findings

Presents cases for specific improvements in client processes in order to improve service delivery and the plan of care, generate cost efficiencies and mitigate risk in alignment with business objectives

Coordinates with case management, psychiatrists and interdisciplinary care team to manage client and clinician situations in an effective manner

Responds urgently to patients’ concerns that jeopardize assignment completion by coordinating with internal sales, operations leaders and stakeholders to make timely and informed decisions

Troubleshoots assignment issues and investigates situation gathering all relevant information with clinicians, clients and internal departments to resolve the problem in a cooperative and collaborative framework

Designs and implements action plans to prevent cancellations and optimize quality performance

Post Graduate Center for Mental Health, New York, NY 3/2014-10/2016

Care Manager Behavior Health Supervisor

Directed supervision of Quality Improvement, Staff Development and Compliance for PGMH Programs

Monitored the quality of therapeutic interventions and reviewed all charts for compliance and quality assurance: assessments, progress notes, and care plans

Supervised care management staff for consultation on case management issues related to providing quality services to clients

Supported Care Management staff as needed when management is in meetings and/or working on other program initiatives

Managed all aspects of Post Graduate Mental Health, including fiscal management, administrative, and service delivery components

Directed internal audits to monitor the effectiveness of PGMH compliance standards and conduct compliance assurance monitoring of potential compliance risk areas

Oversaw daily monitoring of staff productivity and compliance with monthly member outreach calls and annual comprehensive, person-centered care plans

Oversaw Medicaid Billing, including final review of all documentation before billing, submitted weekly billing reports.

Utilized audit reviews of all PGMH programs, to include completion of a plan of correction and working with key staff on completing plans of corrective action.

Developed, implemented and updated policies, procedures and practices designed to ensure compliance with the requirements of the Corporate Compliance Plan and with applicable state and federal laws

Provided performance evaluation review, educated and trained staff as well as developed policies and procedures for all areas of responsibilities

Serviced as point of contact for crisis intervention services, maintained clinical documentation and recorded that uphold all HIPAA regulations

Metropolitan Jewish Health System, Elder Plan, Brooklyn NY 12/2009-2/2014

Manager of Network Operation and Business Development

●Reported to and worked closely with Business Operational Department, call center to identify MJHS Managed Care Insurance financial needs, and ensured that all provider contractual relationships are maintained in compliance with regulatory requirements

●Oversaw daily monitoring of staff productivity and tracking of compliance with monthly member outreach calls and annual comprehensive, person-centered service plan

● Investigated and resolved complaints regarding providers to maintain member and provider satisfaction

●Established and successfully nurtured relationships with vendors and health care providers that led to renewed and new business for the company.

●Oversaw the areas of claim reprising, mailroom, call center/customer service, incoming calls and the quality of providing costumer service

●Ensured that there’s appropriate member service coverage on the phone, facilitated meetings, reviewed and approved workflows

●Identified improvements in overall network operations, including but not limited to contracts management, regulatory guidelines such as network adequacy, compliance with company contract templates, reimbursement structure standards, and other key process controls

●Developed and monitored the performance criteria of members data acquisition, data entry, charge and diagnosis assignment and charge capture activities

●Assisted in the production of measures of physician performance, employing industry standards of quality and efficiency

Metropolitan Jewish Health System, Home First MLTC Insurance, Brooklyn NY 12/2009-2/2011

Clinical Case Manager

Reviewed initial enrollments and continued stay for assigned caseload to determine appropriateness utilizing standardized criteria

Monitored and evaluated effectiveness of care plan and modify plan as needed. Supported member access to appropriate quality and cost-effective care. Acted as a liaison and member advocate between the member/family, physician and facilities/agencies.

Coordinated clinical social work consultation to physicians, professional staff, and other teams’ members/supervisors to provide optimal quality patient care and effective operations.

Researched community resources, coordinated services, trained/created behavioral routines and enabled members to be active participants in their own healthcare

Spring Creek Senior Partners, Brooklyn, NY 02/2006-11/2009

Program Director (Community Senior Program)

Performed quality improvement review to ensure that client records are "audit-ready" at all times

and comply with standards set forth by program funding sources

Ensured the proper administration of the Program by setting goals, monitoring outcomes and enforcing quality standards

Developed and implemented programs as required for Senior Programs including Quality Improvement Project, and Special Needs Plan Model of Care

Conducted and oversaw outreach activities, including presentations to chambers of commerce, and conferences at which public agencies as well as the minority business community may be in attendance

Baruch College, School of Public Affairs, New York, NY 09/2005-05/2008

MPA Master of Public Administration

Long Island University, Brooklyn, NY 09/1998-05/2003

BA in social study and psychology

COMPUTER SKILLS: Working knowledge of Windows, MS Excel, MS Access, PowerPoint, SQL, UAS,

Clinical Management Operational reports, Allscripts, HCS portal, Nextgen Prod, Chart Maxx

Fluent In Russian

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