Experience

Dynamic Healthcare Systems - a Reveleer company

• United States
• Software Development
• 1 - 100 Employee

• Senior Consultant

  • Oct 2014 - Present



John Price Consulting, LLC

• Insurance

• Consultant

  • 2013 - 2013



Horizon Blue Cross Blue Shield of New Jersey

• United States
• Insurance
• 700 & Above Employee

• Manager, Medicare Billing & AR

  • Mar 2011 - Dec 2012



Independence Blue Cross

• United States
• Insurance
• 700 & Above Employee

• Manager, Medicare Enrollment and Reconciliation

  • May 2007 - Mar 2010

  Oversaw data entry, processing and transaction resolution activities for Medicare lines of business. Monthly transactions averaged 5,000+. Managed 4 supervisors, 25 specialists and a business analyst.• Managed processing teams averaging 5,000+ transactions per month. Ensured teams met objectives for production and quality as well as compliance with the Center for Medicare and Medicaid Services (CMS) regulations.• Managed customer service team handling 300+ calls and 100+ written inquiries per week. Monitored established call service standards and quality. • Acted as liaison with external clients to resolve enrollment concerns and educate them on regulations and processes. Improved customer satisfaction and reduced complaints.• Member of several project teams which created and implemented system redesigns and enhancements for 14 product lines.• On a consistent basis, recommended system enhancements, staff training programs and process redesigns. Show less

• Supervisor, Medicare Enrollment Reconciliation

  • Jun 2001 - May 2007

  Responsible for the reconciliation functions associated with Medicare enrollment processing for 4 product lines representing over 300k members. Trained and supervised nine specialists who completed the following processes: transaction reply reports, membership discrepancy reports, special status processes including Working Aged, Institutionalized, and Dual Eligible membership. Team also serviced internal and external customer’s calls and inquiries. Responsible for the review and interpretation of Medicare regulations to assure unit's policy and procedures were compliant. Show less

• Coordinator, Medicare Eligibility Verification

  • May 2000 - Jun 2001

  Coordinated and developed systems enhancements for Medicare Enrollment processing. Commended for ability to quickly learn managed care processes and Medicare regulations regarding Enrollment policies. Based on interpretation of regulations and policies, identified and reported gaps in processes and procedures. Completed research and analysis activities to identify best practices for enrollment and data entry. Liaison between Information Systems department and operational area for problem resolution. Prepared departmental reports used by management for monitoring and trend analysis. Show less



Project Management Institute

• United States
• Professional Training and Coaching
• 700 & Above Employee

• Supervisor

  • Oct 1998 - May 2000

  Responsible for overseeing the administrative, operational, and organizational activities of individual and corporate membership programs. Responsible for overseeing the administrative, operational, and organizational activities of individual and corporate membership programs.