Identified areas for improvement to enhance quality of care .Facilitated investigations and provided corrective actions that improved risk management effectiveness.Complied with regulatory and JCAHO agencies to minimize risks as well as corporate legal with exposure to claims issues.

• Work with treatment team to ensure billing is aligned with the most appropriate level of care for each client•Complete payor pre-notification / pre-certification to obtain approval authorization for treatment provided•Serve as a resource to the treatment team related to denial management and utilization management• Identify opportunities for documentation improvement by ensuring that diagnoses and procedures are documented to the highest level of specificity, accurately address all acute and chronic conditions, and reflect the true health status of patients• Report complete and accurate medical report to insurance companies in a timely manner

• To ensure client satisfaction, staff education, training, caregiver performance, and continually maintain a person-centered business culture that delivers quality, continuous improvement, employee engagement, and high performance• Ensure maximum utilization of caregivers availability and client authorizations/services• Financial duties such as ordering medical supplies; managing the revenue cycle; and overseeing patient billing, claims, and reimbursement• Managing the healthcare facility’s policies and procedures, ensuring that best practices are followed, and resolving cases where the facility is out of compliance

Reactive acquisition of new members via inbound calls. Proactive acquisition of new members via outbound calls. Assess customer needs for products and services using insightful, probing questions and by demonstrating superior listening skills. Cross sell ancillary products as well as any other applicable products to existing members. Retain existing members during annual enrollment period Maintain knowledge levels with respect to government and/or state regulations.*Project management experience collaborating with project managers, analysts and IT to help target specific customers and create spreadsheets and forecast sales *Ability to work both independently and within a team environment backed up by strong organizational and analytical skills

•update necessary changes within the epic billing system •generate and send out invoices•follow up on, collect and allocate payments•carry out billing, collection and reporting activities according to specific deadlines•perform account reconciliations •monitor customer account details for non-payments, delayed payments and other irregularities•research and resolve payment discrepancies •update EOB and COB forms

•Manage patient healthcare information in accordance with MHC regulations. Efforts ensured compliance with HIPPA, CLIA, and OSHA.•Verifies all major insurance and maintain Medicare and Medicaid compliance.•Provides precertification and obtain authorizations prior to patient appointments using automatic eligibility process, various payer websites, and contacting patients for additional information.•Responsible for updating existing insurance and demographic information.

Handled incoming calls from prospective customers or clients and assisted by solving customer disputes. Also, discussed products offered and generated leads in a fast paced environment.

Greet patients and visitors as well as provide the highest level of assistance toemployees, patients and visitors of St. Francis. I work with organizing patient's files, scheduling appointments and verifying insurance to help ensure the smooth operation of the office and optimal delivery of health care services.