Healthcare Payer Enrollment Specialist

• Jun 2023 - Present

Senior Strategic Partner Associate

• Feb 2004 - Feb 2023

In my most recent role, I spearheaded eCommerce/EDI products, payer and trading partner enrollment initiatives, facilitating enrollment between clearinghouse, customers, trading partners, payers, and new trading partnerships. I forged partnerships with customers to add providers and groups, effectively identifying and resolving issues with claims, remittance, and eligibility. I also maintained full accountability for revenue cycle management, as well as ongoing management of trading… Show more In my most recent role, I spearheaded eCommerce/EDI products, payer and trading partner enrollment initiatives, facilitating enrollment between clearinghouse, customers, trading partners, payers, and new trading partnerships. I forged partnerships with customers to add providers and groups, effectively identifying and resolving issues with claims, remittance, and eligibility. I also maintained full accountability for revenue cycle management, as well as ongoing management of trading partners/payers to update changes in enrollment, 5010, and upcoming mandates to ensure compliance and limited customer revenue disruption. • Met with Value Added Resellers during all phases of installation project lifecycle, ensuring streamlined implementation and support. • Completed all set ups including tracking incoming contracts, enrollment confirmations, completion of website set-ups, claim/remit/eligibility routes set up/rejections, and training on product use. • Administered education and training on usage of athenaflex online enrollment tool and Change Healthcare online enrollment tools. • Conducted monthly check-ins with payers to ensure mandate management and impact mitigation. • Partnered with Change Healthcare, Availity, Echo, Cigna to name a few and over 50 payers in enrollment processes and forms submission. Extensively trained internal and external customers. Show less In my most recent role, I spearheaded eCommerce/EDI products, payer and trading partner enrollment initiatives, facilitating enrollment between clearinghouse, customers, trading partners, payers, and new trading partnerships. I forged partnerships with customers to add providers and groups, effectively identifying and resolving issues with claims, remittance, and eligibility. I also maintained full accountability for revenue cycle management, as well as ongoing management of trading… Show more In my most recent role, I spearheaded eCommerce/EDI products, payer and trading partner enrollment initiatives, facilitating enrollment between clearinghouse, customers, trading partners, payers, and new trading partnerships. I forged partnerships with customers to add providers and groups, effectively identifying and resolving issues with claims, remittance, and eligibility. I also maintained full accountability for revenue cycle management, as well as ongoing management of trading partners/payers to update changes in enrollment, 5010, and upcoming mandates to ensure compliance and limited customer revenue disruption. • Met with Value Added Resellers during all phases of installation project lifecycle, ensuring streamlined implementation and support. • Completed all set ups including tracking incoming contracts, enrollment confirmations, completion of website set-ups, claim/remit/eligibility routes set up/rejections, and training on product use. • Administered education and training on usage of athenaflex online enrollment tool and Change Healthcare online enrollment tools. • Conducted monthly check-ins with payers to ensure mandate management and impact mitigation. • Partnered with Change Healthcare, Availity, Echo, Cigna to name a few and over 50 payers in enrollment processes and forms submission. Extensively trained internal and external customers. Show less

Practice Administrator for Dorset St. Cardiology/Cardiac Rehab

• Jan 2003 - Jan 2004

Responsible for ensuring the optimum performance of the daily operations of clinical sites. Managed support functions, patient access, scheduling (office, OR, procedure room, ancillary testing), insurance pre-certification, referral management, resource utilization, transcription, charge capture, service quality, and clinical site staffing. Personnel recruitment, retention, knowledge of medical practice operations and personnel management. Working knowledge of financial… Show more Responsible for ensuring the optimum performance of the daily operations of clinical sites. Managed support functions, patient access, scheduling (office, OR, procedure room, ancillary testing), insurance pre-certification, referral management, resource utilization, transcription, charge capture, service quality, and clinical site staffing. Personnel recruitment, retention, knowledge of medical practice operations and personnel management. Working knowledge of financial performance indicators, medical terminology, diagnostic and procedural coding, regulatory issues, compliance issues and scheduling systems. Ability to lead teams, mentor employees, delegate, communicate effectively, and comfortable adjusting to change Show less Responsible for ensuring the optimum performance of the daily operations of clinical sites. Managed support functions, patient access, scheduling (office, OR, procedure room, ancillary testing), insurance pre-certification, referral management, resource utilization, transcription, charge capture, service quality, and clinical site staffing. Personnel recruitment, retention, knowledge of medical practice operations and personnel management. Working knowledge of financial… Show more Responsible for ensuring the optimum performance of the daily operations of clinical sites. Managed support functions, patient access, scheduling (office, OR, procedure room, ancillary testing), insurance pre-certification, referral management, resource utilization, transcription, charge capture, service quality, and clinical site staffing. Personnel recruitment, retention, knowledge of medical practice operations and personnel management. Working knowledge of financial performance indicators, medical terminology, diagnostic and procedural coding, regulatory issues, compliance issues and scheduling systems. Ability to lead teams, mentor employees, delegate, communicate effectively, and comfortable adjusting to change Show less

Office Manager

• Jan 2001 - Jan 2003

Worked with patients in all phases of their treatment. Mentored patients and other staff members. Presented financial options and set up contracts for patients. Filed all insurance claims for payment and applied the accurate CPT/ ICD9 code. Assisted in creation/implementation of internal/external marketing. Answered phones, scheduled/confirmed appointments, greeted patients, collected/posted all payments, sent recall reminders, typed all letters that went out of… Show more Worked with patients in all phases of their treatment. Mentored patients and other staff members. Presented financial options and set up contracts for patients. Filed all insurance claims for payment and applied the accurate CPT/ ICD9 code. Assisted in creation/implementation of internal/external marketing. Answered phones, scheduled/confirmed appointments, greeted patients, collected/posted all payments, sent recall reminders, typed all letters that went out of the practice. Show less Worked with patients in all phases of their treatment. Mentored patients and other staff members. Presented financial options and set up contracts for patients. Filed all insurance claims for payment and applied the accurate CPT/ ICD9 code. Assisted in creation/implementation of internal/external marketing. Answered phones, scheduled/confirmed appointments, greeted patients, collected/posted all payments, sent recall reminders, typed all letters that went out of… Show more Worked with patients in all phases of their treatment. Mentored patients and other staff members. Presented financial options and set up contracts for patients. Filed all insurance claims for payment and applied the accurate CPT/ ICD9 code. Assisted in creation/implementation of internal/external marketing. Answered phones, scheduled/confirmed appointments, greeted patients, collected/posted all payments, sent recall reminders, typed all letters that went out of the practice. Show less