Operations Manager Project Management
Resume:
Chari L. Jones
810-***-**** (mobile) *********@*****.*********.***
QUALIFICATIONS
A driven IT professional with an educational background in planning,, analyzing and implementing solutions in support of required objectives. The ability to provide comprehensive and secure network design, systems analysis and full life cycle project management. Hands on experience leading all stages of system development efforts, including requirements definition design, architecture, testing and support. Outstanding project and program leader; able to coordinate and direct all phases of project-based efforts while managing, and database administration to communicate and manage contents, motivating and guiding teams to a successful delivery.
ADDITIONAL PROFESSIONAL EXPERIENCE
Contract for Cencora – through AB SpectraForce
Location: Remote – October 2, 2023 – March 15, 2024
Title: Patient Services Representative
Duration: 3-6 months assignment with the possibility to get extended or go permanent.
POSITION SUMMARY:
Under general direction of an Operations Manager, responsible for providing well defined services to patients, providers and
caregivers. Team members will work interactively with patients and their healthcare providers to complete enrollment activities,
answer basic program inquiries, and help coordinate access to therapies through the patient’s healthcare provider.
PRIMARY DUTIES AND RESPONSIBILITIES:
1. Provides advanced services to patients, providers and caregivers. Services could include but not limited:
a) Billing and coding support
b) Claims assistance, tracking and submission
c) Prior authorization assistance and tracking
d) Coordination of benefits
e) Benefit verification result call
f) Welcome calls
g) Advanced alternate coverage research
h) Appeals/Denials
i) Intakes and reports adverse events as directed
2. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and
accurate manner; escalates complaints accordingly.
3. Establishes themselves as regional experts regarding payer trends and reports any reimbursement trends/delays to
management team (e.g. billing denials, claim denials, pricing errors, payments, etc.).
4. Processes any necessary correspondence.
5. Coordinates with internal and external service providers to ensure services are performed in accordance with program
policy and within expected service level agreements (SLA).
6. Maintains confidentiality in regards to all patient sensitive information.
7. Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises
judgment within defined standard operating procedures to determine appropriate action.
8. Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with
defined standard operating procedures. Management will monitor queues and provide active feedback as required.
9. Performs related duties as assigned, could include well defined services generally performed by other program
representatives (e.g. benefit verifications, PAP determinations).
Contract for Centene – through
Healthcare Solutions - Remote - September, 2022 – February, 2023
Provider Relation Specialist – Submit applications to the Credentialing Committee for review, perform credentialing verification and request information from the appropriate data banks, Verify information from the providers malpractice insurer, regarding State License and Education / Training, Outreach with providers to ensure their timely renewal of expiring licenses and certifications, Credential and Re-credential Practitioners and Physicians Applications in accordance with the joint commission program, Provide support to external provider data issues, Create Provider Load Form (PLF), Maintaining Provider Database System, work with Citrix, Centene, WellCare, CenProv, SharePoint, Xceleys, Medicare, Medicaid. Track, update NPI, Taxonomy, audit provider data, Initiate and process providers by adding, changing and terminating forms, Create and maintain spreadsheets used to produce provider directories for multiple products, Submit provider data entries to resolve provider related demographics and Identify what to add, delete and update to key provider groups and model contracts.
Contract for Genesee Power Station – through
APS – Onsite – June, 2022 – August, 2022
Worked primarily as administrative working with Outlook, Word, Excel, Quick Books, weighing packages, using machine to apply postage to packages, keeping track of incoming and outgoing materials, dealing with Compliance to Audits and HIPPA etc, etc
Contract for State of Michigan - through
Robert Half Staffing – Remote – October, 2020 – June, 2021
Agent - worked remotely answering questions for claimant, processing unemployment claims, making sure documents were completed correctly in order for claimant to receive benefit payments, updating files to better serve the customers etc. etc….
TG Staffing
Administration / Coordinator March, 2020 – June 2020
Serve as primary contact for housing assistance from both survivors and community partners.
work with individual clients providing appropriate victim services including crisis intervention, emergency safe housing, advocacy, peer counseling, emergency services, referral to other agencies and accurate documentation.
Ascertain the housing needs and available resources of persons seeking aid and work with them to determine what is available to them.
Coordinate process of lease - up, landlord negotiations, and contracts
Coordinate of donation and storage of housing program donations and facilitation of connecting appropriate donations to survivors in need.
Coordinate of cleaning, turnover and transition of safe house and transitional housing units to meet needs of survivors in a timely manner.
Generate resources in the area of housing, including; researching available affordable and supportive housing options, developing relationships with landlords and housing programs. Engage landlords to create housing opportunities.
Representing the organization holding community meetings regarding housing issues for homeless population and assisting with educating the community on changing policy which relates to victim access for affordable housing.
Coordinate VOCA funding available to assist victims of crime on a variety of needs to promote long - term housing stability
A LIL MORE HANDS - Flint, MI Accounts Receivable March, 2019 – February. 2020
Entech Staffing /Ascension Health - Flint, MI January, 2019 – February, 2019
Quality Data Analyst
Promote maintenance of participant health, Business and Data Analyst,Contracts Monitoring for Quality and Compliance, Lead Meeting Agenda Meetings, Registration, Annual Quality Management Summary, Use QAPI Database, Use CMS Conference Call Worksheet for Incidents, Data Policy and Procedures, Participate in required quality assessments and continuous improvements such as; infection and safety control standards, Medical Records Management Policy and Procedures, Supporting technical systems / medical records information for electronic (EMR), Complete appointment scheduling, utilization review medical terminology, patient registration, Complete projects of some sort relating / demonstrating system design, documents, work plans, test new, information technology, EMR (Epic), data collection, Answer incoming and outgoing calls – Call Center, Pull reports using different systems / codes, Provide administration support intake / claque and clerical responsibilities, Chart/ Auditing, Maintain medical records, Medical Billing / Coding (ICD), SQL (Structured Query Language), ART & BLS and SAP Systems
ALTEGRA HEALTH / CHANGE HEALTH, Flint MI December, 2016 –August 2018
FIELD REVIEWER ADVOCATE
Registration, document management -scanning and saving patients documents, Reviewing information that has been scanned, Epic Certified, Attaching documents to EMR & LIDS, Uploading & managing charts
Electronic Medical Billing, Records (EMR) - Epic System, Coding / ICD9, Inventory, Distribute contract information status updates, Chart Acquisition Process and Coversheets, Traveling Field Reviewer
Project Base, Participate in quality assessments and improvements, Ability to identify and solve problems HIPPA CERTIFIED
UAW LOCAL 659, Flint MI April 2015 – August 2017
SQL Database Administrator /ADMINISTRATIVE RECEPTIONIST
Procedures establish ways to perform a certain task like an action plan for team to perform their duties Proving detailed information to Union Reps, Documenting and keeping track of all Legal Binding information, Modifying event flyers, Scheduling meetings for the President, Recording proceedings of all membership, Handle appeals and take care of union correspondence, Lead the meetings for the collective bargaining power to negotiate with employers, Create spreadsheets for financial contributions regarding fundraisers, Cobra payments and tracking past and existing collections.
Various computer programs used such as; Outlook, PowerPoint, Excel, Microsoft, Overnight packages and sending email along with creating Flow charts,etc. etc.
Procedures used in SQL Database:
1.Perform Database installation and configuration, Query Optimization and performance turning, wrote/maintained SQL Queries.
2.Hand on Data Integrity Validation Designed and Implemented Data Access stored procedures and triggers for automating tasks.
3.Recovered Database in the event of disaster by developing and maintaining relational structures including back/recovery and log shipping procedures.
4.Replicated Data to different servers created and modified stored procedures generated reports and analyzing data.
5.Implemented and maintained security integrity controls including backup and disaster recovery strategies
6.Collecting Data and Information to allow viewing, access and managing in order to save time and be able to store huge amounts of data.
ENTECH AGENCY HEALTHPLUS OF MICHIGAN, Flint MI Nov 2013 – Dec 2014
IT PROVIDER NETWORK ANALYST
Initiating, documenting, tracking and screening provider application request by:
Developing and maintaining accurate provider application materials and contract templates, SAP Systems
Coordinate credentialing process with Quality Management Credentialing Department
Send out necessary documents for provider applications i.e. W-9, Intake, Contracts Forms, etc.
Monitor database on an ongoing basis to maintain integrity of data and identify and resolve data issues contained therein.
Responsible for organization and corporate reporting provider network data utilized in and reported through the Corporate Score Card and the Presidents Report.
Communicate with provider, internal and external customers, such as PHO Administrators to facilitate and track status of provider application requests, provider record change request to ensure HealthPlus provider database is accurately maintained for external publication.
Provide on-going status reports of e provider credentialing process to Provider Network Management, Legal and Physician Hospital Organizations and others, as applicable.
Maintain on-going communication with IS, Provider Network Management and Customer Service Departments to ensure provider data is consistently updated, accurately reflected in multiple system and current on he corporate website, at all times.
Produce customized provider directories for all product lines for external and website use by: employer groups, County Health Plans, Sales and Services, PHO and PO’s
Direct involvement in the analysis and recruitment of providers.
Other duties as assigned
Work on special projects for different departments
Complete the 020 Process Steps by closing out and implementing notes for PIM, LEGAL and Credentialing Department.
Mailing out contracts to providers and ensuring the addresses are correct.
Upgrading spreadsheets for P.N.M. Department, SAP Systems
Report injuries to CMS FOR Medicare purposes
Access medical records using healthcare systems
Medical Billing / Coding
Complete request from Law Firms, Hospitals, Insurance Companies and Doctor’s Offices
PITNEY BOWES, Flint, MI May 1996 – Feb 2009
Follow Up Team Leader
Processed Warranty claims from other vendors by handling incoming and outgoing documents that consisted of personal data for General Motors, Handle express packages: Fed-Ex, U.P.S. and DHL,
Place orders throughout the GM Facility for customers/employees using Boise.
Directed workflow by providing service to customers that consisted of sorting, processing and distributing mail, Proofread corporate material, made necessary modifications and communicated changes throughout organization, Examined work queues for requests in jeopardy of missing service agreements, SAP Systems, Lead meetings concerning contracts, checks, accounts payable, inventory, stock market, benefits, discrepancies, incoming and outgoing process packages; etc. etc
EDUCATION
Associate of Applied Science, Computer Information Systems Sept, 2009 May, 2011
University of Davenport, Grand Rapids, Michigan
CERTIFICATIONS IN PROGRESS & COMPLETED TECHNICAL PROFICIENCIES
CISSP CERTIFIED Information System ISSA Information System Security Association
MOSC Microsoft Office Specialist Certification A + Certification, 2011
Platforms: UNIX, Windows 9x/NT/2000/XP/Vista, Linux, Mac OS, VM/370
Networking: TCP/IP, Novell, DECNET, SO/OSI, IPX/SPX, SMS /SQL, EHTERNET Secure ID, PGP, PKI, PAYMENT HSMS, HARDWARE & SOFTWARE SECURITY, MOBILE DEVICES, VPN
MANAGEMENT & AUTHENTICATIION
Tools/Applications: Lotus Notes Excel & Microsoft Office Suite Data Entry Visual Basic Fox Pro
COBOL dBase IV Microsoft Money Olympic System Drivers Analytical
CEO (Computer) Flowcharts Quality Control Professional File Problem solving
MICROSOFT DYNAMICS
RECOGNITION
Letters of outstanding service from parents, teachers and students
Received High Reviews
Awarded Certificate of Achievement in Customer Service Star
Employee of the Month
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