Experience

Medallion

• United States
• Technology, Information and Internet
• 1 - 100 Employee

• Payer Enrollment Team Lead

  • Nov 2022 - Present



Envision Physician Services

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Supervisor of Provider Payer Enrollment and Training Specialist

  • Feb 2020 - Nov 2022

  Develop and implement new training programs and materials to new and existing employees and upstream management. Facilitate individual and group training sessions online and in person. Oversee new hire orientation, training and assessment. Responsible for researching and communicating process changes to leadership and continuing education to existing employees. Present department overview to Regional and Site Medical Director and new hire orientations.• Subject matter expert of provider enrollment procedures and payer requirements, with information pertaining to operations in all required states.• Selected by VP of Enrollment to lead a work group initiative aimed at reducing of write offs through claim denial tracking and management. Successfully guided the team in developing and launching a shared tracking mechanism, via SmartSheet, that allows the billing and enrollment teams to track, manage and resolve claim denials in real time thus significantly reducing communication delays. On track to reduce monthly write offs by $110K/month.• Utilize eLearning tools to create and maintain written SOP’s, classroom handouts, instructional materials, aids and manuals.• Design and facilitate all classroom-based and virtual training, including new hire orientation. • Train key stakeholders in the correct processes for completing online and paper applications; researched payer tools and devised printed training materials.• Assist employees and leadership with payer conflict resolutions thus increasing positive outcomes in effective date and denial disputes, most recently preventing $300k in write offs.• Assess and communicate payer procedures and forms changes across the company to increase standardization of processes.

• Trainer- Lead Provider Enrollment Specialist

  • Aug 2011 - Feb 2020

  Specializing in provider enrollment staff training and payor conflict resolution. Charged with overseeing all aspects of provider enrollments for several insurance programs. Adheres strictly to correct processes for preparing and sending partially prepopulated applications for all new providers for up to 15 divisional contracts, submitting applications to payors and ensuring that all required documents are returned on time; payors include, but are not limited to Medicare, Medicaid, Blue Cross Blue Shield, and Tricare. Investigates claims that have been rejected due to enrollment errors, and takes action to resolve those errors. Facilitates increased enrollments by cultivating positive business relationships with payors. Develops training materials and conducts group and one-on-one training sessions both online and in person. Accountable for writing Standard Operating Procedures (SOP), handling a significant amount of money held in Accounts Receivable, and updating payor policies.• Decreased A/R from $15M to under $6M in 2 ½ months for 15 contracts, a 60% reduction. Lessened application deficiencies by submitting applications in a timely manner that were completed correctly and had all required documentation• Developed the most extensive knowledgebase of procedures and payer requirements used by the company, with information pertaining to operations in 10 states.• Devised Excel spreadsheets to manage providers, high-volume contracts, payors, and monies held in Accounts Receivable (A/R).• Trained team members in the correct processes for completing online applications; researched several tools and devised printed training materials.



Diagnostic Clinic Medical Group PA

• United States
• Medical Practices
• 1 - 100 Employee

• Patient Registration Clerk

  • Oct 2009 - Aug 2011

  Audited reports to ensure that all appointments have been reconciled and charged for billing. Accountable for verifying patient demographic and insurance eligibility at check-in, entering all CPT (Current Procedural Terminology) and ICD-9 (International Classification of Diseases) codes for billing purposes as directed by the physician, collecting patient copays and balances, printing balance statements, answering patient billing questions, and scheduling patient appointments in the electronic scheduling system.• Acquired the ability to assist in all functional areas of the clinic including Check-in, Laboratory, Ophthalmology, Primary Care, and other specialty areas.• Chosen to train all new Patient Registration Clerks in check-in / check-out, appointment scheduling, and other procedures as ordered by providers.



A Therapy Above, Inc.

• Administrative Assistant / Receptionist

  • Sep 2008 - Oct 2009

  • Scheduled all new patient intakes and patient appointments using an electronic scheduling system.• Accountable for answering all incoming calls, calling patients to remind them of appointments the following day, requesting all medical records from outside physicians and hospitals, and maintaining medical files. • Scheduled all new patient intakes and patient appointments using an electronic scheduling system.• Accountable for answering all incoming calls, calling patients to remind them of appointments the following day, requesting all medical records from outside physicians and hospitals, and maintaining medical files.



ROKOSZ Media, Inc.

• Sales Account Executive / Video Production Assistant

  • Mar 2007 - Dec 2007

  • Increased revenues by negotiating and closing sales for video productions that included commercials, instructional / how-to videos, and live productions.• Accountable for representing the company at networking and marketing events, assisting the director during video shoots, setting up and tearing down sets, and keeping video logs. • Increased revenues by negotiating and closing sales for video productions that included commercials, instructional / how-to videos, and live productions.• Accountable for representing the company at networking and marketing events, assisting the director during video shoots, setting up and tearing down sets, and keeping video logs.



Brown & Brown

• United States
• Law Practice
• 1 - 100 Employee

• Account Executive Assistant – Insurance Brokerage / Commercial Marine Department

  • Apr 2004 - Mar 2007

  Assisted the Account Executive by issuing and processing insurance policies, Endorsements, Certificates of Insurance, and Endorsement requests. Accountable for obtaining necessary underwriting information, contributing to office revenue goals, and handling applications, inspections, surveys, compliance, and premium bookings.• Promoted to Account Executive Assistant from Processor / Technical Assistant in under 1 year. Assisted the Account Executive by issuing and processing insurance policies, Endorsements, Certificates of Insurance, and Endorsement requests. Accountable for obtaining necessary underwriting information, contributing to office revenue goals, and handling applications, inspections, surveys, compliance, and premium bookings.• Promoted to Account Executive Assistant from Processor / Technical Assistant in under 1 year.