Experience

Fundamental

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Manager of Provider Relations and Physician Credentialing

  • Jan 2020 - Oct 2021

  Las Vegas, Nevada Area Responsible for managing the credentialing of multiple skilled nursing facilities and Hospitals across the nation. Responsible for answering any questions in regards to contracting, created and maintained a Contract Summary Resource spreadsheet for all facilities. Created various resources to organize all managed care contracts per State and Facility. Assist the department Vice President with the complete execution of new agreements or amendments with Managed Care companies. Assist the billing… Show more Responsible for managing the credentialing of multiple skilled nursing facilities and Hospitals across the nation. Responsible for answering any questions in regards to contracting, created and maintained a Contract Summary Resource spreadsheet for all facilities. Created various resources to organize all managed care contracts per State and Facility. Assist the department Vice President with the complete execution of new agreements or amendments with Managed Care companies. Assist the billing department with any claim’s issues related to contracting. Responsible for Physician Credentialing for two NV Hospitals and two SNF. Sent applications for new and existing providers through MD-App. Confirmed all supporting documents were included and verified. Ensured all providers were registered in the National Provider Data Base and notified the facilities of any Red Flags. Prepared providers to be presented in the Medical Executive Committee for full privileges. Show less



Anthem, Inc.

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

• Network Relations Consultant

  • Jun 2017 - Jan 2020

  Las Vegas, Nevada Area Responsible to research, analyze and recommend resolution for contract dispute, non-routine claim issues, billing questions and other practices. Liaison between provider and internal departments. Coordinate communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. Maintain and develop positive relationships with the provider community by periodic on-site visits, communicating administrative or programmatic changes and… Show more Responsible to research, analyze and recommend resolution for contract dispute, non-routine claim issues, billing questions and other practices. Liaison between provider and internal departments. Coordinate communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. Maintain and develop positive relationships with the provider community by periodic on-site visits, communicating administrative or programmatic changes and facilitating the resolution of provider issues. Coordinates and conducts provider training. Show less



University of Miami

• United States
• Higher Education
• 700 & Above Employee

• Supervisor, Patient Access - Central Insurance Verification

  • Nov 2016 - Mar 2017

  Miami/Fort Lauderdale Area Responsible for the supervision of the daily activities of the Insurance Verification Specialist. Ensures all staff members adhere to all established policies and procedures related to the department and continuously monitors compliance. Motivates employees through the use of positive reinforcement and recognition of employee problems with efforts to resolve these problems. Provide immediate service recovery by taking ownership of any problems that may arise and resolving them utilizing… Show more Responsible for the supervision of the daily activities of the Insurance Verification Specialist. Ensures all staff members adhere to all established policies and procedures related to the department and continuously monitors compliance. Motivates employees through the use of positive reinforcement and recognition of employee problems with efforts to resolve these problems. Provide immediate service recovery by taking ownership of any problems that may arise and resolving them utilizing appropriate rationale. Assists in monitoring staff productivity and quality of work through proactive reviews of attendance, data entry, registration information, etc. Complete employee time records in Workday. Performs year end evaluations and new hire 90-evaluations.

• Senior Medical Collector

  • Nov 2015 - Nov 2016

  University of Miami Responsible for preparing bundle billing for AvMed DRG, KAF, Transplant and International Embassy contracts. Accountable for scrubbing patient accounts and verifying charges from different guarantor accounts. Verify coverage's as needed for case rate associations. Prepare invoices for billing. Communicate with academic departments for release of charges and claim edit completions. Serve as back up for fee for service follow up within the team. Maintain a running spreadsheet for all billing and… Show more Responsible for preparing bundle billing for AvMed DRG, KAF, Transplant and International Embassy contracts. Accountable for scrubbing patient accounts and verifying charges from different guarantor accounts. Verify coverage's as needed for case rate associations. Prepare invoices for billing. Communicate with academic departments for release of charges and claim edit completions. Serve as back up for fee for service follow up within the team. Maintain a running spreadsheet for all billing and collections for the International Embassy lines of business.



Amerigroup

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

• Member Liaison

  • Jun 2014 - Jul 2015

  Las Vegas, Nevada Area Responsible for member retention by investigating and leading the resolution of member complaints. Serve as a liaison/mediator between member, the provider and Plan, Provide education to the member on Medicaid Managed Care and their benefits with AMERIGROUP, informing and ensuring that members are aware of their rights and responsibilities, the complaint process, and health education activities available in the community. Support member outreach activities/events. Provide member education to… Show more Responsible for member retention by investigating and leading the resolution of member complaints. Serve as a liaison/mediator between member, the provider and Plan, Provide education to the member on Medicaid Managed Care and their benefits with AMERIGROUP, informing and ensuring that members are aware of their rights and responsibilities, the complaint process, and health education activities available in the community. Support member outreach activities/events. Provide member education to help improve our HEDIS scores. Responsible for coordination of denial letters process including tracking, trending and reporting. Responsible for coordination of Medical Advisory Committee, Quality Management Committee and Quality Sub-Committee meetings. Including, creating calendar invite, taking and transcribing meeting minutes, creating meeting agenda and collecting any additional information from various departments to be presented in the meeting. Show less



Dr. Fredric Brandt, Dermatology & Skin Cancer Institute, Inc.

• Patient Care Coordinator

  • Feb 2011 - Mar 2014

  Coral Gables, Florida Prepare itemized statements, bills, or invoices and record amounts due for items purchased or services rendered. Compile data, compute fees and charges, and prepare invoices for billing purposes. Answer customers' questions about merchandise and advice customers on merchandise selection. Itemize and total customer merchandise selection at checkout counter, using cash register, and accept cash or charge card for purchases. Maintain daily logs to balance end of day reconciliation. Take inventory… Show more Prepare itemized statements, bills, or invoices and record amounts due for items purchased or services rendered. Compile data, compute fees and charges, and prepare invoices for billing purposes. Answer customers' questions about merchandise and advice customers on merchandise selection. Itemize and total customer merchandise selection at checkout counter, using cash register, and accept cash or charge card for purchases. Maintain daily logs to balance end of day reconciliation. Take inventory or examine merchandise to identify items to be reordered or replenished. Assist billing department with insurance verification, obtained prescription and procedure prior authorizations and posting. Familiar with Medical Software such as Care cloud, Advance MD, ACCPACC, Avisena and Innovation. Operate typing, adding, calculating, or billing machines. Show less



Select Physical Therapy

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

• Patient Service Representative

  • Nov 2009 - Feb 2011

  Miami, Florida Scheduled patient appointments or medical consultations. Answered telephones and direct calls to appropriate staff. Operated office equipment, such as voice mail messaging systems, and use word processing, spreadsheet, or other software applications to prepare reports, invoices, financial statements, letters, case histories, or medical records. Operated telephone switchboard to answer, screen, or forward calls, providing information, taking messages, or scheduling appointments. Greeted persons… Show more Scheduled patient appointments or medical consultations. Answered telephones and direct calls to appropriate staff. Operated office equipment, such as voice mail messaging systems, and use word processing, spreadsheet, or other software applications to prepare reports, invoices, financial statements, letters, case histories, or medical records. Operated telephone switchboard to answer, screen, or forward calls, providing information, taking messages, or scheduling appointments. Greeted persons entering establishment, determined nature and purpose of visit, and directed or escorted them to specific destinations. Responsible for verifying patients insurance benefits prior to appointment. Show less



Greater Miami Skin and Laser Center

• United States
• Medical Practices

• Medical Records / Referral Coordinator

  • Mar 2007 - May 2009

  Miami Beach, Florida Protected the security of medical records to ensure that confidentiality is maintained. Reviewed records for completeness, accuracy, and compliance with regulations. Retrieved patient medical records for physicians, technicians, or other medical personnel. Operated medical practice software Avisena. Responsible for verifying patients insurance benefits prior to appointment and obtaining prior authorizations for office visits and procedures.



Continucare Corporation

• Hospitals and Health Care
• 1 - 100 Employee

• Switchboard Operator

  • Jun 2006 - Jan 2007

  Miami, Florida Answered incoming calls, greeting callers, providing information, transferring calls or taking messages as necessary. Operated communication systems, such as telephone, switchboard, intercom, two-way radio, or public address. Paged individuals to inform them of telephone calls, using paging or interoffice communication equipment.



Office Depot

• United States
• Retail Office Equipment
• 700 & Above Employee

• Sales Associate Cashier

  • Feb 2006 - Jun 2006

  Miami, Florida Greeted customers and ascertain what each customer wants or needs. Described merchandise and explain use, operation, and care of merchandise to customers. Recommended, select, and help locate or obtain merchandise based on customer needs and desires. Received payment by cash, check, credit cards, vouchers, or automatic debits. Issued receipts, refunds, credits, or change due to customers. Assisted customers by providing information and resolving their complaints.



Health South Rehabilitation

• United States
• Higher Education
• 1 - 100 Employee

• Office Clerk

  • Jun 2004 - May 2005

  Hialeah, Florida Operated office machines, such as photocopiers and scanners, facsimile machines, voice mail systems, and personal computers. Answered telephones, direct calls, and take messages. Maintained and update filing, inventory, mailing, and database systems, either manually or using a computer.