Experience

Family Health Network

• Hospitals and Health Care
• 1 - 100 Employee

• Project Manager

  • May 2014 - Present

  • Direct, execute, and manage a project management plan from project initiation to closure. • Define project scope, goals and deliverables that support business goals in collaboration with senior management and stakeholders. • Develop full-scale project plans and associated communication documents. • Effectively communicate project expectations to team members and stakeholders in a timely and clear fashion. • Collaborate with project stakeholders on an ongoing basis. • Estimate the resources and participants needed to achieve project goals. • Set and manage/control project expectations with team members and other stakeholders. • Delegate tasks and responsibilities to appropriate personnel. • Identify and resolve issues within the project team. • Identify and manage project dependencies and critical path. • Plan and track project timelines and milestones using appropriate tools. • Develop and deliver progress reports, proposals, required documentation, and presentations. • Analyze and audit results. Troubleshoot problem areas. • Proactively manage changes in scope, identify potential crises, and devise contingency plans. • Define project success criteria and disseminate them to involved parties throughout project life cycle. • Build develop and grow any business relationships vital to the success of the project. Show less



Vein Clinics of America

• United States
• Medical Practices
• 200 - 300 Employee

• Lead Credentialing Coordinator

  • May 2012 - Present

  • Completes physician credentialing/contracting with all insurers and other payers including Medicare. • Reviews all applications for completeness, accuracy and compliance with standard procedures and applicable Federal and State regulatory guidelines.• Resolves issues concerning credentialing/recredentialing with payers.• Completes and submits EDI, ERA, and EFT applications.• Establish and maintains a network of key contacts from provider reps to senior level network management with various carriers to expedite and encourage credentialing and contract execution• Maintains/manages fee schedules, physician credentialing databases, CAQH profiles and contract agreement files.• Gate keeper for commercial billing (responsible for reviewing reports to ensure accuracy)• Obtain initial physician state licenses and manage renewals/reinstatements.• Assist with medical policy appeals.• Assist with denial and collector payer contract challenges.• Working knowledge of credentialing and contracting with government and commercial carriers.• Proficient knowledge of ICD-9, CPT-4, HIPAA standard EDI and manual claim submission, ERA, EFT implementation. Show less

• Executive Assistant/Clinical Research Coordinator

  • Feb 2011 - May 2012

  • Proof reports (Word and Power Point, in particular) for grammar, punctuation and presentation quality and format. • Maintain calendars for the President & Corporate VPs, planning and scheduling meetings, teleconferences and travel arrangements. Prepare expense reports for the President• Assist the President & Corporate VPs with coordination of annual meetings, symposiums Strategic Planning meetings, etc. Tasks include off-site selection, hotel and ground transportation reservations; room set-up arrangements, meal selections, preparation of presentation materials and handouts. Participate as onsite coordinator to ensure a smoothly run meeting. Review and execute final invoice reconciliation.• Coordinate the President’s participation in Board meetings. Schedule monthly Forecast meetings and schedule Staff meetings take minutes and provide support as needed. Schedule, create, maintain and distribute yearly Corporate Calendar of all company meetings and events. • Contribute to team effort by pitching in and assisting the Marketing Team with meetings & events as needed.• Greet guests and customers in person, or on the telephone answering or directing inquiries.• Assist with clinical research trials. Ensure research site personnel are performing according to the clinical protocol and regulatory requirements. Ensure reporting of adverse event from research site staff to sponsor and IRB/IEC. Verify data in Case Report Forms to ensure they are in agreement with source documents. Review accuracy and completeness of site records. Verify investigational product accountability. Complete reporting and ensure management and resolution of all these activities (e.g. visit reports, trial management tracking system). Conduct routine monitoring visits on behalf of the clinical trial sponsor. Show less

• Project Coordinator

  • Feb 2010 - Feb 2011

  • Maintain current licensure, CME, liability facesheets, board certifications, educational/training certificates, and make hospital “transfer of care” arrangements for all physicians. • Maintain permit and facility certificates based on state regulations.• Research top carriers in a particular market, laws and regulations on a local and federal level to assist with reimbursement• Obtain fee schedules and renegotiate contractual rates.• Complete physician/facility enrollment applications and manage individual/group contracts for clinics covering 14 states.• Credentialing data entry in Vistar (credentialing software), scanning, filing of information in an organized manner.• Investigate and analyze claim issues due to credentialing issues. Communicate findings and suggest solution to appropriate staff. Show less



Redwood Regional Medical Group

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Clinic Mgr, Admin Asst to VP of Ops, Credentialing Spec., Lead Float Patient Services rep

  • Mar 2007 - May 2009

  • Traveled to various clinics within RRMG to help cover a wide range of positions within the front office in Medical Oncology, Radiation Oncology, Radiology and Breast & Vascular Surgery. • Checking patients in/out, new patient coordinating, scheduling appointments and surgical procedures, patient education, authorizing outpatient procedures from a wide range of health plans and understanding drugs and biologics compendium for chemotherapy and standard practices for Radiation treatment as well as providing data for various clinical research trials. • Directed, trained, evaluated, mentored, and managed a multi-specialty clinic with both Medical Oncology and Radiation Oncology with all aspects of their duties, responsibilities, and accountabilities. Staff includes nurses, radiation therapists, and front office staff. Addressing and resolving billing issues. Ordering clinic office and medical supplies. Hold monthly meetings to discuss changes, address providers’ needs and minimize workflow issues for the front office. • Maintain over 45 providers’ credentialing by meeting requirements and deadlines for: medical licensure, DEA, UPIN, Tax ID’s, and uploading NPI numbers; Norcal insurance coverage; handling disputes; re-credentialing process to maintain privileges and rights within assigned hospitals; registration and fees for Continuing Medical Education. • Planning, troubleshooting and modifying programs within Metinformatix using Crystal Reports, which is originally designed for radiology EMR to accomodate RRMG’s other specialties. Data input, employee training, implementation of the program and optimization. • Administrative assistant to the VP of operations and Human Resources includes scheduling/setting up meetings/conferences, managing provider and locum schedules/vacations in accordance to state law, and creating manuals for satellite offices. Show less



Cancer Care and Hematology Specialists (U.S. Oncology)

• Patient Services Representative

  • Oct 2006 - Mar 2007

  • Greeting and checking patient in/out, scheduling appointments, answering/triaging phone calls • Verifying eligibility of insurance and fulfilling requirements to ensure maximum benefits to the patients • Arranging hospital admissions, diagnostic testing, and other services to maintain their treatment regimen • Greeting and checking patient in/out, scheduling appointments, answering/triaging phone calls • Verifying eligibility of insurance and fulfilling requirements to ensure maximum benefits to the patients • Arranging hospital admissions, diagnostic testing, and other services to maintain their treatment regimen



Touch of Health (Buffalo Grove, IL)

• Patient Services Representative / Internship

  • May 2006 - Sep 2006

  • Verify patient insurance of eligibility; verify and resolve claims; accounting (resolve and report aged account receivables) • Renegotiate physicians’ contracts with various insurance companies to maximize revenue; market the clinic to utilize all available office space to interested physicians and the clinic’s billing/insurance staff to promote outsourcing to other practicing physicians. • Work with Medicare provider and relations; installation of new medical billing system with Mysis software; review all CPT and ICD-9 codes along with fee schedules for 12 physicians • Update the procedure manual (new employee orientation and policy booklet) along with job descriptions; answer and direct phone calls (schedule appointments); file and update patient records Show less



Children's Mercy Hospital

• United States
• Hospitals and Health Care

• Pediatric Nurses Assistant (GI and Cardiac Unit)

  • Sep 2000 - Mar 2003

  • Take vital signs, bathe, feed, monitor, and provide care for cardiac and upper GI patients. • Stock medical supplies; clean; document, monitor, and report activities to physicians and nurses. • Act as a patient advocate by providing nurturing behaviors such as holding, rocking, playing with, and talking to the patient to stimulate and encourage infant/child growth and development particularly with patients with minimal to no parent interaction. • Act as a parent advocate by recognizing areas of possible assistance and information by pointing them in the direction of accessible resources. Show less



Shawnee Mission Medical Center

• United States
• Medical Practices
• 1 - 100 Employee

• Mental Health Nurses Assistant

  • Jan 2001 - Aug 2001

  • Take vital signs, bathe, feed, monitor and provide care for patients in all age groups (young adults, adolescents, geriatric, etc). • Document, monitor, and report activities and responsive patient behavior to physicians and nurses. • Use interpersonal skills to gain patients’ trust as part of the care provider team to maximize patients’ comfort and allow them to be open to receive treatment. • Take vital signs, bathe, feed, monitor, and provide care for cardiac and upper GI patients. • Stock medical supplies; clean; document, monitor, and report activities to physicians and nurses. • Act as a patient advocate by providing nurturing behaviors such as holding, rocking, playing with, and talking to the patient to stimulate and encourage infant/child growth and development particularly with patients with minimal to no parent interaction. • Act as a parent advocate by recognizing areas of possible assistance and information by pointing them in the direction of accessible resources. Show less