Customer Service Quality Assurance
Resume:
Fairburn, GA *****
*******@*****.***
Objective To obtain a long term, professional position in Healthcare Business Operations or Office Management.
Work Experience Emory Healthcare Decatur, Georgia
May 16, 2011 to Present Credentialing Verification Specialist Responsibilities
Ensures that Emory and its staff's credentials meet government and accrediting agency standards.
To verify the legitimacy of practitioner information with universities, licensing agencies and certification groups. Along with processing re-credentialing paperwork and maintaining a database of practitioners' training, education, licensing and experience.
Effectively use the Cactus Software system in conjunction with other computer programs to compile data and report sets.
Work with strict deadlines to ensure that Emory staff and applicants meet reappointment deadlines and initial start dates.
Effectively use customer service and service recovery skills to maintain positive communication with internal and external Clients.
Dr. Richard Krakow, Dermatology Practice Roswell, GA
Feb 2008 – July 31, 2009 Front Office Responsibilities Coordinator
Coordinate front office workflows which include: patient check in/out,
Scheduling, billing, claims processing and customer service.
Verification and entry of variable medical insurance provider information for claims processing to include Medicare and Medicaid.
Multiple phone lines
Customer Service
Provide Pt billing information
Kaiser Permanente Atlanta, GA
Nov 2004 – Feb 2007 Business Office
Responsibilities Supervisor
Support the day to day operations of a single Patient Business Office
Coordinate activities with section leaders to ensure compliance with policies, procedures and regulatory requirements.
Train and audit administrative personnel in the areas of:
o Patient check in/out processes
o Cash collections
o Coding/ ICD9, CPT4
o Quality Assurance
Direct customer service and service recovery
Patient Account specialist for internal and external clients
Accounts receivable/Medicare reimbursement
Work daily with Epic/Resolute, IRCS, Mass 200, and Cadence
Reconciliation, Posting to General Ledger and deposits for Med Office and Pharmacy
Report Generation and Analysis from Cadence and Epic systems
Workman’s Compensation
Kaiser Permanente Denver, CO
December 2002 – September 2004 Business Office Coordinator
Responsibilities Advanced Wound Care Dept.
Project Management/ Wound Care Program Design, Implementation, Presentation, and Training
Design of information databases and quantitative reporting formats to support analysis of product utilization, cost savings, and outcomes.
Review of business systems and processes and make recommendations for more efficient systems.
Consult and collaborate with internal and external teams regarding Program management/utilization.
Assist with daily operations of the Advanced Wound Care Center and Plastic Surgery departments.
Assume management responsibility in Managers absence.
Coordination annual competency training/development workshop
Direct customer service and service recovery
Review and authorization of inbound referrals, assure proper ICD9/CPT coding
University of Colorado Hospital Aurora, CO
August 1997 – December 2001 Care Team Coordinator OB/GYN
Responsibilities Women’s Center
Coordination of administrative and service quality operations for four departments: Physician practice, Resident practice rotations, Midwifery program, and Maternal Fetal Medicine.
Oversee all scheduling activities to include creation of Physician and Resident Master Schedules.
Oversee Front and back office workflows.
Supervision of 15 front and back office staff /Schedulers and MA's
Experience with Managed Care, Medicaid, Medicare Authorizations and Billing, UB92, HCFA 1500 filing, ICD9 and CPT Coding.
Financial Counseling/Colorado Indigent Care Program (CICP)
Customer Service, Service Recovery, and Issue Resolution.
Planning, Implementation and training of new call center systems.
Project Development - Successful practice relocation
Employee recruitment, selection, and retention.
The Product Line Denver, CO
August 1995– August 1997 Lead Processor/Accounting Office
Responsibilities
Responsible for the supervision of back office, batch processing team
Accounts receivable, Counting and batching cash, checks, money order, and credit card orders in essence of about 10,000 a day
BI-weekly bank deposits
Expanded processing efficiency from 50 to 90 Percent
Education 2006 Real Estate License State of Georgia
2003-2004 Colorado Christian University Lakewood, CO
BA, Business Administration (Unfinished)
1995-1997 Parks College Aurora, CO
A.A.S Business Administration/Medical Office Emphasis
1999-2001- Various Supervisory courses at University of Colorado Hospital
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