T. Renee Piper, NCICS
Client Manager Implementations at Versant Health- Claim this Profile
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Bio
Credentials
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NCICS- National Certified Insurance & Coding Specialist
National Center for Competency Testing (NCCT)Dec, 2014- Nov, 2024
Experience
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Versant Health
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United States
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Insurance
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300 - 400 Employee
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Client Manager Implementations
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Feb 2011 - Jul 2018
Main primary point of contact for assigned Account Management clients. This may include onsite visits, with the frequency of such visits determined by client size and servicing needs Hosting implementation conference calls or webinars with client representatives on a proactive basis to ensure the client’s satisfaction and vendor clarification Developing implementation plans for new and renewal client’s expectation. Provide updates at various intervals throughout the implementation… Show more Main primary point of contact for assigned Account Management clients. This may include onsite visits, with the frequency of such visits determined by client size and servicing needs Hosting implementation conference calls or webinars with client representatives on a proactive basis to ensure the client’s satisfaction and vendor clarification Developing implementation plans for new and renewal client’s expectation. Provide updates at various intervals throughout the implementation process from initiation thru completion Documenting initial process, process updates, meeting minutes, and workflow process during implementation. Responding to initial and post implementation inquiries serving as an internal historical resource Assist and liaise with internal partners such as IT, Claims, Credentialing, Customer Service, Legal, Provider Relations, and Quality Management staff in the preparation and delivery of successful implementation. Ensure timely and accurate delivery of program documentation to clients, including but not limited to provider listings, Geo Access Network Analysis, Provider Network Disruption Analysis for RFPs, CMS regulatory reports, quality assurance and claims encounter data reporting Prepare, participate, and coordinate follow-up activity pertaining to client delegated oversight audits Respond to implementation and growth request received form clients, i.e. member expansion, provider panel expansion, addition of benefit designs/products, member eligibility changes, and service area expansion Interface with Operations team to ensure the company’s operations comply with assigned client’s expectations, updates, and future deliverables Transition successful implementation accounts to assigned Account Manager Show less Main primary point of contact for assigned Account Management clients. This may include onsite visits, with the frequency of such visits determined by client size and servicing needs Hosting implementation conference calls or webinars with client representatives on a proactive basis to ensure the client’s satisfaction and vendor clarification Developing implementation plans for new and renewal client’s expectation. Provide updates at various intervals throughout the implementation… Show more Main primary point of contact for assigned Account Management clients. This may include onsite visits, with the frequency of such visits determined by client size and servicing needs Hosting implementation conference calls or webinars with client representatives on a proactive basis to ensure the client’s satisfaction and vendor clarification Developing implementation plans for new and renewal client’s expectation. Provide updates at various intervals throughout the implementation process from initiation thru completion Documenting initial process, process updates, meeting minutes, and workflow process during implementation. Responding to initial and post implementation inquiries serving as an internal historical resource Assist and liaise with internal partners such as IT, Claims, Credentialing, Customer Service, Legal, Provider Relations, and Quality Management staff in the preparation and delivery of successful implementation. Ensure timely and accurate delivery of program documentation to clients, including but not limited to provider listings, Geo Access Network Analysis, Provider Network Disruption Analysis for RFPs, CMS regulatory reports, quality assurance and claims encounter data reporting Prepare, participate, and coordinate follow-up activity pertaining to client delegated oversight audits Respond to implementation and growth request received form clients, i.e. member expansion, provider panel expansion, addition of benefit designs/products, member eligibility changes, and service area expansion Interface with Operations team to ensure the company’s operations comply with assigned client’s expectations, updates, and future deliverables Transition successful implementation accounts to assigned Account Manager Show less
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FORTIS Colleges and Institutes
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Higher Education
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500 - 600 Employee
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Allied Health Instructor- Medical Billing & Coding
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May 2012 - Sep 2016
•Provide instruction to adult students in the areas of Medical Billing and Coding Program •Provide training on CMS-1500, UB04, and ADA Claim processing via electronic and paper submission •Demonstrate proper methods of patient registration, insurance verification, billing, and collection techniques •Reading and interpretation of Insurance EOBs to post accurate payments for accounts receivables •Demonstrate proper coding concepts of ICD-9/10-CM, CPT, and HCPCS coding •Grades… Show more •Provide instruction to adult students in the areas of Medical Billing and Coding Program •Provide training on CMS-1500, UB04, and ADA Claim processing via electronic and paper submission •Demonstrate proper methods of patient registration, insurance verification, billing, and collection techniques •Reading and interpretation of Insurance EOBs to post accurate payments for accounts receivables •Demonstrate proper coding concepts of ICD-9/10-CM, CPT, and HCPCS coding •Grades tests, projects, and other assignments in a required timeframe. •Provide assistance for the planning, development, and maintenance of program curriculum. •Remain in compliance with Maryland Higher Education Commission (MHEC) education standards Show less •Provide instruction to adult students in the areas of Medical Billing and Coding Program •Provide training on CMS-1500, UB04, and ADA Claim processing via electronic and paper submission •Demonstrate proper methods of patient registration, insurance verification, billing, and collection techniques •Reading and interpretation of Insurance EOBs to post accurate payments for accounts receivables •Demonstrate proper coding concepts of ICD-9/10-CM, CPT, and HCPCS coding •Grades… Show more •Provide instruction to adult students in the areas of Medical Billing and Coding Program •Provide training on CMS-1500, UB04, and ADA Claim processing via electronic and paper submission •Demonstrate proper methods of patient registration, insurance verification, billing, and collection techniques •Reading and interpretation of Insurance EOBs to post accurate payments for accounts receivables •Demonstrate proper coding concepts of ICD-9/10-CM, CPT, and HCPCS coding •Grades tests, projects, and other assignments in a required timeframe. •Provide assistance for the planning, development, and maintenance of program curriculum. •Remain in compliance with Maryland Higher Education Commission (MHEC) education standards Show less
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Sr. Provider Network Analyst Geo Networks
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Jun 2009 - Mar 2010
Acting Team Lead for the Network Analyst team in Sales Operations Responsible for responding to the network access and disruption analysis componets on vision and dental RFPs Analyze the network accessibility of provider networks to a customer's employee or member population, as well as, disruption risk in evaluating the RFP Accountable for generating reports, analysis and summary recommendations for Sales in responding to RFPs on new or renewal business Retrieve dental and vision… Show more Acting Team Lead for the Network Analyst team in Sales Operations Responsible for responding to the network access and disruption analysis componets on vision and dental RFPs Analyze the network accessibility of provider networks to a customer's employee or member population, as well as, disruption risk in evaluating the RFP Accountable for generating reports, analysis and summary recommendations for Sales in responding to RFPs on new or renewal business Retrieve dental and vision provider data files to create the monthly master data files for the team Prepare and manipulate the provider data files using Excel/Access formats for GEO Access and Disruption Analysis system tools Monitor the provider databases to ensure the current information was accessible to the team Assign and monitors workload of staff analyst Accountable for employee performance managemeent, coaching and development Participates in training, communication, development, and implementation of new processes and tools Show less Acting Team Lead for the Network Analyst team in Sales Operations Responsible for responding to the network access and disruption analysis componets on vision and dental RFPs Analyze the network accessibility of provider networks to a customer's employee or member population, as well as, disruption risk in evaluating the RFP Accountable for generating reports, analysis and summary recommendations for Sales in responding to RFPs on new or renewal business Retrieve dental and vision… Show more Acting Team Lead for the Network Analyst team in Sales Operations Responsible for responding to the network access and disruption analysis componets on vision and dental RFPs Analyze the network accessibility of provider networks to a customer's employee or member population, as well as, disruption risk in evaluating the RFP Accountable for generating reports, analysis and summary recommendations for Sales in responding to RFPs on new or renewal business Retrieve dental and vision provider data files to create the monthly master data files for the team Prepare and manipulate the provider data files using Excel/Access formats for GEO Access and Disruption Analysis system tools Monitor the provider databases to ensure the current information was accessible to the team Assign and monitors workload of staff analyst Accountable for employee performance managemeent, coaching and development Participates in training, communication, development, and implementation of new processes and tools Show less
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Cigna Healthcare
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Hospitals and Health Care
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700 & Above Employee
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Sr. Provider Relations Analyst
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Sep 2007 - Dec 2008
Managed relationships with key prominent medical groups, hospitals and ancillary providers. Maintained regular contact with key provider organizations and acts as their liaison to internally resolve complex issues. Implemented provider demographics and contracted fee schedules into the database Resolved daily incoming escalated provider inquiries. Resolve inquiries by researching root cause of error, resolution and provider education Negotiated routine provider contracts and fee… Show more Managed relationships with key prominent medical groups, hospitals and ancillary providers. Maintained regular contact with key provider organizations and acts as their liaison to internally resolve complex issues. Implemented provider demographics and contracted fee schedules into the database Resolved daily incoming escalated provider inquiries. Resolve inquiries by researching root cause of error, resolution and provider education Negotiated routine provider contracts and fee schedules Provided support to the Provider Relations management team by implementing processes and coordinating special projects Show less Managed relationships with key prominent medical groups, hospitals and ancillary providers. Maintained regular contact with key provider organizations and acts as their liaison to internally resolve complex issues. Implemented provider demographics and contracted fee schedules into the database Resolved daily incoming escalated provider inquiries. Resolve inquiries by researching root cause of error, resolution and provider education Negotiated routine provider contracts and fee… Show more Managed relationships with key prominent medical groups, hospitals and ancillary providers. Maintained regular contact with key provider organizations and acts as their liaison to internally resolve complex issues. Implemented provider demographics and contracted fee schedules into the database Resolved daily incoming escalated provider inquiries. Resolve inquiries by researching root cause of error, resolution and provider education Negotiated routine provider contracts and fee schedules Provided support to the Provider Relations management team by implementing processes and coordinating special projects Show less
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Sr. Network Development Specialist
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Jun 2004 - Sep 2007
Assisted Manager of Gateway Service Unit supervising a team of 5 associates Ensured team associates provide timely resolutions according to department unit standards Performed cross training, development, coaching and feedback to maintain quality metrics Assisted in developing and implementing process and procedures for an effective unit Coordinated with Access (Medicaid) eligibility on members initial, reinstatement and termination of benefits Ensured Facets eligibility… Show more Assisted Manager of Gateway Service Unit supervising a team of 5 associates Ensured team associates provide timely resolutions according to department unit standards Performed cross training, development, coaching and feedback to maintain quality metrics Assisted in developing and implementing process and procedures for an effective unit Coordinated with Access (Medicaid) eligibility on members initial, reinstatement and termination of benefits Ensured Facets eligibility files mirrored Medicaid database consistently Managed the dental provider network for Gateway Health Plan of Pennsylvania (MCO) Maintained and building relationships with Medicaid dental providers Managed the Orthodontia line of business including, inquires, claims, and providers Performed claim research, special projects, and complex claim investigations Negotiated participating provider fees schedules and non participating provider fees Performed provider education via conference call, emails, and faxes Recruited providers for the expansion of the dental network Show less Assisted Manager of Gateway Service Unit supervising a team of 5 associates Ensured team associates provide timely resolutions according to department unit standards Performed cross training, development, coaching and feedback to maintain quality metrics Assisted in developing and implementing process and procedures for an effective unit Coordinated with Access (Medicaid) eligibility on members initial, reinstatement and termination of benefits Ensured Facets eligibility… Show more Assisted Manager of Gateway Service Unit supervising a team of 5 associates Ensured team associates provide timely resolutions according to department unit standards Performed cross training, development, coaching and feedback to maintain quality metrics Assisted in developing and implementing process and procedures for an effective unit Coordinated with Access (Medicaid) eligibility on members initial, reinstatement and termination of benefits Ensured Facets eligibility files mirrored Medicaid database consistently Managed the dental provider network for Gateway Health Plan of Pennsylvania (MCO) Maintained and building relationships with Medicaid dental providers Managed the Orthodontia line of business including, inquires, claims, and providers Performed claim research, special projects, and complex claim investigations Negotiated participating provider fees schedules and non participating provider fees Performed provider education via conference call, emails, and faxes Recruited providers for the expansion of the dental network Show less
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Customer Communications Specialist
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May 2003 - Jan 2004
Interfaces with customers and brokers via telephone, written correspondence, fax, web, and or electronic mail to respond to inquiries and resolve concerns, including those of difficult and challenging nature Researched customer information by effectively using resources to respond to inquiries including, but not limited to, enrollment, authorizations, payments, denials and coordination of benefits and eligibility Assisted customers during Open Enrollment Benefit season regarding current… Show more Interfaces with customers and brokers via telephone, written correspondence, fax, web, and or electronic mail to respond to inquiries and resolve concerns, including those of difficult and challenging nature Researched customer information by effectively using resources to respond to inquiries including, but not limited to, enrollment, authorizations, payments, denials and coordination of benefits and eligibility Assisted customers during Open Enrollment Benefit season regarding current benefits, new benefit changes benefit exclusions and insurance cards Assisted customers with Life Changing scenarios: newborn children, adoption, marriages, divorce and death Assisted customers with primary and specialist physicians, as well as, ancillary referrals Investigated analyzed and resolved outstanding issues to achieve customer satisfaction; uses a systematic approach in solving problems through analysis and evaluation of alternate solutions. Served as a training resource and mentor to new employees. Show less Interfaces with customers and brokers via telephone, written correspondence, fax, web, and or electronic mail to respond to inquiries and resolve concerns, including those of difficult and challenging nature Researched customer information by effectively using resources to respond to inquiries including, but not limited to, enrollment, authorizations, payments, denials and coordination of benefits and eligibility Assisted customers during Open Enrollment Benefit season regarding current… Show more Interfaces with customers and brokers via telephone, written correspondence, fax, web, and or electronic mail to respond to inquiries and resolve concerns, including those of difficult and challenging nature Researched customer information by effectively using resources to respond to inquiries including, but not limited to, enrollment, authorizations, payments, denials and coordination of benefits and eligibility Assisted customers during Open Enrollment Benefit season regarding current benefits, new benefit changes benefit exclusions and insurance cards Assisted customers with Life Changing scenarios: newborn children, adoption, marriages, divorce and death Assisted customers with primary and specialist physicians, as well as, ancillary referrals Investigated analyzed and resolved outstanding issues to achieve customer satisfaction; uses a systematic approach in solving problems through analysis and evaluation of alternate solutions. Served as a training resource and mentor to new employees. Show less
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Provider Relations Coordinator
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Feb 2002 - Mar 2003
Developed and sustained strong mutually beneficial relationships with providers and their office staff. Acted as a liaison between the physician, ancillary providers and hospitals. Facilitated the provider's understanding of company products, policies and procedures. Ensured contract compliance and interpretation through education. Reviewed contracts to ensure agreements are properly implemented into the database. Utilized the necessary guidelines to correct changes or update… Show more Developed and sustained strong mutually beneficial relationships with providers and their office staff. Acted as a liaison between the physician, ancillary providers and hospitals. Facilitated the provider's understanding of company products, policies and procedures. Ensured contract compliance and interpretation through education. Reviewed contracts to ensure agreements are properly implemented into the database. Utilized the necessary guidelines to correct changes or update the provider's profile to ensure smooth transition of claims and payment. Assisted in credentialing department projects, assist with National Practitioner Data Base research, assemble initial applications packets, document received applications. Performed initial or re-credentialing site visits, orientation, service visits and recruitment Provided assistance with training for new employees. Show less Developed and sustained strong mutually beneficial relationships with providers and their office staff. Acted as a liaison between the physician, ancillary providers and hospitals. Facilitated the provider's understanding of company products, policies and procedures. Ensured contract compliance and interpretation through education. Reviewed contracts to ensure agreements are properly implemented into the database. Utilized the necessary guidelines to correct changes or update… Show more Developed and sustained strong mutually beneficial relationships with providers and their office staff. Acted as a liaison between the physician, ancillary providers and hospitals. Facilitated the provider's understanding of company products, policies and procedures. Ensured contract compliance and interpretation through education. Reviewed contracts to ensure agreements are properly implemented into the database. Utilized the necessary guidelines to correct changes or update the provider's profile to ensure smooth transition of claims and payment. Assisted in credentialing department projects, assist with National Practitioner Data Base research, assemble initial applications packets, document received applications. Performed initial or re-credentialing site visits, orientation, service visits and recruitment Provided assistance with training for new employees. Show less
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Provider Relations Correspondent
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Mar 1997 - Jun 2000
Primary functions were handling correspondence and telephone inquiries from providers, hospitals, group administrators regarding benefits, claims, eligibility, coverage cancellations, billing and reimbursement. Ensured accurate dissemination of information by mastering new products, benefit changes, conversion guidelines, and jurisdictional mandates. Initiated appropriate action to resolve problems including claim adjustments, enrollment updates and referrals to support areas. Managed… Show more Primary functions were handling correspondence and telephone inquiries from providers, hospitals, group administrators regarding benefits, claims, eligibility, coverage cancellations, billing and reimbursement. Ensured accurate dissemination of information by mastering new products, benefit changes, conversion guidelines, and jurisdictional mandates. Initiated appropriate action to resolve problems including claim adjustments, enrollment updates and referrals to support areas. Managed and monitor inquiries daily in accordance with corporate guidelines ensuring timeliness in the resolution of inquiries and goal attainment. Show less Primary functions were handling correspondence and telephone inquiries from providers, hospitals, group administrators regarding benefits, claims, eligibility, coverage cancellations, billing and reimbursement. Ensured accurate dissemination of information by mastering new products, benefit changes, conversion guidelines, and jurisdictional mandates. Initiated appropriate action to resolve problems including claim adjustments, enrollment updates and referrals to support areas. Managed… Show more Primary functions were handling correspondence and telephone inquiries from providers, hospitals, group administrators regarding benefits, claims, eligibility, coverage cancellations, billing and reimbursement. Ensured accurate dissemination of information by mastering new products, benefit changes, conversion guidelines, and jurisdictional mandates. Initiated appropriate action to resolve problems including claim adjustments, enrollment updates and referrals to support areas. Managed and monitor inquiries daily in accordance with corporate guidelines ensuring timeliness in the resolution of inquiries and goal attainment. Show less
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Education
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1996 - 1997
Applied Career Training
Certificate/Diploma, Medical Office Administration -
1991 - 1993
Howard University
Associate Degree
Community
