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| Desired Industry: Healthcare |
SpiderID: 11955 |
| Desired Job Location: Phoenix, az, Arizona |
Date Posted: 3/26/2007 |
| Type of Position: Full-Time Permanent |
Availability Date: now |
| Desired Wage: open |
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U.S. Work Authorization: Yes |
| Job Level: Experienced with over 2 years experience |
Willing to Travel: Yes, Less Than 25% |
| Highest Degree Attained: Other |
Willing to Relocate: No |
Objective:
Seeking a position using my extensive knowledge and successful experience within the Healthcare Industry
Experience:
CAREER PROFILE
· Extensive experience in the Healthcare sector ranging from customer service to administrative responsibility.
· Self-motivated, efficient, resourceful, dependable and reliable under pressure.
· Excellent communication and interpersonal skills.
· Detail oriented and resourceful in completion of tasks with ability to multi-task effectively.
· Demonstrated ability to function effectively as a team player as well as working independently to achieve objective.
· Possess strong problem resolution and customer service skills.
· Dedicated to achieving a reputation for consistently going beyond what is required.
PROFESSIONAL EXPERIENCE
HEALTHCARE GROUP OF ARIZONA Phoenix, AZ
Customer Care Manager 2005-2007
· Managed the daily operations of the Healthcare Group Customer Care call center.
· Functioned as a liaison with other departments to expedite business operations and to ensure problem resolution and facilitate excellent working relationships and customer service with plan members and providers
· Assisted in health plan compliance ensuring membership data integrity with contracted health plans
· Ensured monthly premium billings, enrollments and plan renewals were processed timely
· Developed policies and procedures to ensure compliance with plan requirements and benefit administration
· Prepared, developed and maintained training documents for desk level reference
· Maintained and managed productivity reports generated by call center systems
· Oversaw claims administration and appeals
VISTACARE, INC Scottsdale, AZ
Funding Verification/Benefit Specialist 2004-2005
· Responsible for processing the eligibility and prior authorization functions of the Finance department for the corporate office.
· Verified benefits for commercial insurance plans, Medicaid managed care plans, Veteran Administration and Medicare coverage on all patients referred and admitted to 50 VistaCare hospice programs
· Updated patient records to assure consistency and accuracy for billing
· Negotiated individual contracts and rates for billing all levels of hospice care
· Built relationships with insurance company case managers and promoted VistaCare as a preferred provider
· Updated and maintained insurance contracts and payor sources for accurate billing and reimbursement
· Provided customer service, support and training to over 50 hospice sites
PEARSON GOVERNMENT SOLUTIONS Phoenix, AZ
Supervisor (Temporary Position) 2004
· Responsible for supervising employees to assure productivity, quality and timelines in fast-paced, high volume call center for the Center for Medicare and Medicaid Services (CMS) providing assistance to the 1-800-MEDICARE help line
· Monitored calls to ensure consistent quality and high level of customer satisfaction to Medicare beneficiaries
· Assured all customer service and contractual service levels were met daily
· Reviewed contract scope and requirements for customer service excellence
· Conducted weekly staff training sessions for new Medicare benefits
· Reviewed call reports and processed payroll reports for staff
MAYO CLINIC HOSPITAL Scottsdale, AZ
Patient Financial Services Supervisor 2000—2003
· Managed the daily operations of the Patient Financial Services customer service unit
· Ensured that all patient and insurance problems were handled efficiently and resolved appropriately
· Developed a quality monitoring system and scripts to ensure superior customer service and improve patient satisfaction
· Established and implemented a departmental customer service award
· Streamlined operating standards and work flows and decreased backlog while improving customer satisfaction and collections
· Developed and implemented all policies and procedures
· Supervised and trained staff through an extensive computer conversion
· Interfaced and coordinated with other departments and committees, to ensure continuous improvement for the organization, customer satisfaction, compliance with billing requirements for ICD9 and HCPCS coding
TRIWEST HEALHCARE ALLIANCE Phoenix, AZ
Call Center Supervisor 1996—2000
· Assisted with the coordination and implementation of the start up operation for the CHAMPUS/TRICARE Department of Defense managed care contract and a new call center
· Interviewed, hired, trained and supervised staff
· Created and implemented workflows, policies and procedures
· Assisted in enrollment of military beneficiaries into a new healthcare program
· Developed a new call monitoring system and implemented and maintained daily monitoring of calls and handling of all elevated problems, complaints and reported results weekly
· Extensive knowledge of plan benefits, authorizations and referral procedures for HMO, PPO, and Indemnity product
· Interfaced and coordinated with other departments and customer service centers in 16 states with regional staff at 27 military installations to ensure customer satisfaction and contract compliance in the managed care program
LOOMIS & ASSOCIATES, INC Phoenix, AZ
Customer Service Manager 1988—1996
· Responsible for the management of a customer service unit, receptionist, clerical staff and medical records staff, providing specialty billing and claim follow for out-of- state Medicaid beneficiaries.
· Managed staff servicing 900 hospital providers/clients
· Monitored and handled inquires, complaints, insurance follow up, collections, marketing and billing of claims
· Maintained and updated all client data, receivables and consistently attained collection goals
· Extensive knowledge of medical claims, follow up, denial analysis and Medicaid state agencies
· Researched federal regulations for state specific billing requirements and communicated with fiscal intermediaries
· Implemented various procedures, goals and objectives, accomplishing timely and efficient processing of claims
COMPUTER SKILLS
Microsoft Windows, Outlook, Word, Excell, Novell, IDX, HealthQuest, Swithview/ACDPlus, Lucent Centre Vu, Witness
Next Generation Desktop, Optika, Cisco, Siebel, and Claimstat
Education:
EDUCATION
Taylor Business Institute, Plainfield, NJ
Woodbridge High School, Woodbridge, NJ
Candidate Contact Information:
| Name: Janet Fitzsimmons |
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| Street: |
Phone: 480-563-8609 |
| City: Phoenix |
Fax: - |
| State: Arizona |
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| Zip: 85050 |
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| Web Site: |
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