Alicia Rhoads Email & Phone Number

Norristown, Pa, Us

West Reading, Pa, United States

Works with internal and external constituents to resolve accounts receivable, access to care, provider enrollment, coordination of benefits, and other issues occurring between the Health System and payors resulting in impactful financial recoveries. Internal constituents include Revenue Cycle, Enrollment/Credentialing, Revenue Integrity, Contracting, Patient Access and Cash Posting. Key Accomplishments/Skills:-Negotiates Single Case Agreements for the hospital system.- Resolves Experian plan mapping issues.-Completes special projects as required.-Compiles/tracks current issues and completes follow up with the payors as appropriate. -Reviews and interprets contracts to pinpoint and resolve open issues regarding denials/variances/appeals.-Performs contract reviews for new/renewing payors to identify and suggest contract language changes to promote operational excellence. -Researches coding, billing and policies to determine coverage/value for potential/existing services,-Resolves time sensitive access to care issues for various facilities and providers to ensure patients receive the necessary care. -Facilitates joint operating committee (JOC) meetings with payors to ensure all issues are properly escalated, tracked and resolved. -Administers Managed Care Department SharePoint which includes creating, designing, and maintenance of all pages.Proficient in Outlook, Excel, Word, PowerPoint, Epic, OnBase, Ntracts, Cactus, ServiceNow, Availity, Navinet, Various Payor Portals, and SharePoint.

Blue Bell, Pa

Acted as a single point of contact for a plan sponsor’s benefit personnel regarding member related issues or general administration matters. Traveled to annual enrollment/new customer meetings and answered member questions regarding their health and prescription plans. Supported the Account Manager with the installation of new and existing customers regarding products, structure, billing, eligibility, and member materials. Traveled to sales meetings and assisted retirees with benefits questions.Key Accomplishments/Skills:Executed ID cards from end to end including design, quality assurance review and release/mailing. This sometimes-included custom designs.Ensured accuracy of the EOCs prior to mailing to members.Resolved complex benefits and claims issues via phone calls with retirees. Trained and mentored co-workers (new and existing) regarding all aspects of the position.Plan Sponsor Tool and SharePoint Administrator for plan sponsor pages which included the initial design of new pages, and maintenance of existing pages for assigned plan sponsors and co-worker’s pages. Managed a book of business of fifteen plan sponsors including two high profile employers. Proficient in Outlook, Excel, Word, Archer, QuickBase, MARx UI (CMS.Gov), Sharepoint, Salesforce, and numerous Aetna applications.

Blue Bell, Pa

Supported the Public Exchange in conjunction with the Centers for Medicare & Medicaid Services to meet customer’s eligibility needs. Reviewed and processed 834 enrollment files while following CMS guidelines. Verified enrollment status, processed changes to member records, and addressed a variety of enrollment concerns. CMS complaint liaison in addition to completing general complaints, and Department of Insurance complaints for all Individual Public Exchange membership.Key Accomplishments/Skills:Reviewed and updated electronic 834 enrollment files daily. Corrected any fallout records by performing manual corrections in the eligibility system.Managed Department of Insurance (DOI), Executive and all other complaints and appeals according to regulatory timeframes for the on-exchange team.Assisted with pulling invoices and phone calls for billing audits.Reviewed trial bills monthly and completed adjustments and refunds.Completed Health Plan Services, Health Plan Systems Disaster, and Health Rules Payor user acceptance testing and provided feedback as required.Entered Enrollment Resolution & Reconciliation forms for Federally Funded Marketplace orphans.Submitted XOSC (Exchange Operations Support Center) tickets to CMS.Enrollment backup to the immediate supervisor.Manually enrolled newborns according to company standard and completed letters to the members advising how to complete permanent enrollment through the Marketplace.Part of the Level 1 HICS (Health Insurance Casework Systems) Team which handled high priority escalations from the Marketplace which included night/weekend coverage.Return to Sender check processing.Created Policies & Procedures (P&P's) for Billing and Enrollment Departments.Proficient in Outlook, Excel, Word, QuickBase, Health Rules Payor, Oracle, and numerous Aetna applications.

Blue Bell, Pa

Received inbound calls from members regarding eligibility, benefits, and claims questions for National Accounts such as the State of New Jersey, Comcast, Rohm and Hass, Lockheed Martin and Johnson & Johnson. Resolved eligibility, benefits, claims, prior authorization, and pharmacy issues received from plan sponsor in the customer advocate role. Coached and mentored co-workers as a team coach and also as a team lead. Walked teammates through difficult calls, reviewed calls regularly for quality assurance, provided one on one training to struggling teammates, and de-escalated calls with irate members. Performed quality review of calls for team monthly. Achieved SLA/KPI requirements as required by team.

Plymouth Meeting, Pa

Seasonal Position assisting visual manager with merchandising and decorating the store for the holiday. Followed visual guides and planograms from corporate to create appealing displays. Assisted the signing team as needed to ensure racks were merchandised and priced correctly. Performed resets of merchandising areas. Also performed overnight inventory as needed.

North Wales, Pa

Managed the Fine Jewelry department and employees - responsibilities included reconciliation of safe and contents of cases, receiving of new merchandise, return of damaged/returned merchandise, watch repairs, high dollar sales of diamonds and gold, sales/returns, pricing/signing, merchandise resets, merchandising, diamond testing, scheduling, inventory, markups/markdowns, loss prevention and customer service.Supervision of 5-6 employees and financial responsibility of 1 million dollars.

Pennsville, Nj

Started as a part-time Sales Associate, then promoted to full-time Assistant Manager. Responsibilities included opening/closing store, preparing tills for day and balancing tills at night, auditing of safe, preparing daily deposit for the bank, loss prevention, receiving of merchandise via truck, UPS orders and returns, general supervision of employees, human resources responsibilities such as interviewing/hiring employees, scheduling, merchandising, markups/markdowns, sales/returns, inventory, and customer service. Also managed the shoe, fashion jewelry, fragrance, handbag and accessories departments. Supervision of 8-10 employees and financial responsibility of 1 million dollars.

Bridgeton, Nj

Opened mail, sorted checks and prepared for billing to post. Also performed miscellaneous administrative jobs such as filing, scanning and copying.

Vineland, Nj

Part time position as a sales associate. Responsibilities included assisting customers with purchases and returns, completing layaway purchases, fitting room reconciliation, unloading trucks, general merchandising, sales floor resets, ensuring products were signed correctly, preparing sales floor for opening/closing, and gift wrapping items.

Accounting

Health/Health Care Administration/Management