Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. . May perform any or all of the folowing in the enrollment of providers: determines the acceptability of provider enrollment applications (which may be used for initial full application, reenrollment, reactivation, change of information); provides in-depth… Show more Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. . May perform any or all of the folowing in the enrollment of providers: determines the acceptability of provider enrollment applications (which may be used for initial full application, reenrollment, reactivation, change of information); provides in-depth review and verification/validation of provider data; verifies provider data by use of information databases and various organizations/agencies to ensure authenticity; sets up/tests EFT accounts.Processes/enters/updates provider data information/applications into appropriate enrollment database used in evaluating/tracking the processing of the application and/or updating of provider directories. Provides quality service and communicates effectively with external/internal customers in response to inquiries (correspondence, telephone). Obtains information from internal department, providers, government and/or private agencies, etc. to resolve discrepancies/problems.Supplies enrollment applications and general information on the enrollment process to interested enrollees.Contributes to and participates on special projects related to provider files. Assists Technical Support staff with testing system changes related to provider files. Assists with process improvements related to Provider Enrollment. Assists with provider education and provider services training. Show less

Conduct inspections/surveys/investigations of healthcare facilities, service providers, and/or applicants. Evaluates the activities to determine the degree to which standards are carried out effectively. Identify conditions that do not meet standards. Advise personnel administering activities and services to develop a plan of correction to remedy deficiencies, prevent their reoccurrence, and improve overall quality control and compliance with standards.Completes written reports of… Show more Conduct inspections/surveys/investigations of healthcare facilities, service providers, and/or applicants. Evaluates the activities to determine the degree to which standards are carried out effectively. Identify conditions that do not meet standards. Advise personnel administering activities and services to develop a plan of correction to remedy deficiencies, prevent their reoccurrence, and improve overall quality control and compliance with standards.Completes written reports of deficiencies and submits all reports of findings and required documentation in a timely manner. Ensure that all files pertaining to the survey are secured in accordance with HIPAA and in adherence to federal and state laws. Meets deadlines on written correspondence, documentation, and data entry. Abides by stringent rules regarding the completion of agency forms and practices pertaining to travel, reimbursement, training and the use of state and federal resources. Serves as a team leader to a survey team. Conducts pre-survey/inspection/investigation team meetings, reviews of survey findings, entrance and exit interviews, travel arrangements and directions to survey team when serving as team leader. Represents team as a spokesperson or liaison for survey when needed. Must be knowledgeable of all applicable regulations, policies and procedures.  Show less

Provided support through evaluation of member’s electronic file system, helping members achieve and maintain optimal wellness by guiding both family and member to appropriate resources with regards to member’s care and wellbeing.- Performed varied activities and moderately complex administrative / operational / customer support assignments using semi routine computations to support members nonclinical needs.- Assigned 550 members to assist with telephonic affairs concerning… Show more Provided support through evaluation of member’s electronic file system, helping members achieve and maintain optimal wellness by guiding both family and member to appropriate resources with regards to member’s care and wellbeing.- Performed varied activities and moderately complex administrative / operational / customer support assignments using semi routine computations to support members nonclinical needs.- Assigned 550 members to assist with telephonic affairs concerning health, wellness, fitness, medication and other insurance or benefit necessities they may be entitled to utilize on their insurance plan. - Followed standard policies and procedures that allow for independent interpretation / deviation and independent discretion based on level of knowledge. - Worked with defined parameters to identify work expectations and quality standards but has limited latitude over prioritization and works under minimal direction. Show less

Gathered information by telephone from veterans,  veteran’s dependent and beneficiaries to counsel on the multiple benefits that are available to Veterans and their family.- Ensured information is properly communicated to caller by asking clarifying questions and follow up questions.- Provided Veterans a connection to alternate resources that can be determined to be more suitable to their needs.- Reviewed electronic files to assist with determining the status of… Show more Gathered information by telephone from veterans,  veteran’s dependent and beneficiaries to counsel on the multiple benefits that are available to Veterans and their family.- Ensured information is properly communicated to caller by asking clarifying questions and follow up questions.- Provided Veterans a connection to alternate resources that can be determined to be more suitable to their needs.- Reviewed electronic files to assist with determining the status of documentation submitted for processing.- Informed  callers of the most current status of claims and appeals while discussing information to support the claim and/or appeal.- Proficient in administrative duties to include: providing resourceful training documents, coordinated team meetings as well as shared contact numbers and references- Supported department by assisting with multiple office functions and encouraged team morale. Show less

Pre-registered and registered patients for scheduled appointments as well as walk-in services. Provided excellent customer service to patients, visitors, and co-workers requiring assistance within the facility or over the telephone.- Prepared and verified all patient accounts for inpatient and outpatient services and billing for clinical services while reporting to a Patient Access Manager.- Completed Medicare Secondary Payer (MSP) questionnaire on all applicable… Show more Pre-registered and registered patients for scheduled appointments as well as walk-in services. Provided excellent customer service to patients, visitors, and co-workers requiring assistance within the facility or over the telephone.- Prepared and verified all patient accounts for inpatient and outpatient services and billing for clinical services while reporting to a Patient Access Manager.- Completed Medicare Secondary Payer (MSP) questionnaire on all applicable patients.- Made appropriate reference to payment arrangements or financial programs when necessary; retrieved copies of identification and insurance cards from all patients while obtaining signatures on all pertinent consent forms to record in the document scanning.- Reviewed all regulatory documentation with patients while educating patients on their rights and responsibilities; access numerous online databases to obtain clinic schedules, insurance information and relative patient information.- Assisted patients with inprocessing for inpatient care and completed check-in and checkout for pediatric specialty clinics and after hours care clinic. Show less

Increased office operational capabilities by 50% by performing general office duties to include answering multi-line telephones, utilization of the fax machine and copier, and ensured the safety and security of the facility; contributed to the functionality of the facility by assisting the front desk personnel with duties including medical records and greeting clients.- Utilized the computer system and Medicaid Web based system to help determine a client’s eligibility based on… Show more Increased office operational capabilities by 50% by performing general office duties to include answering multi-line telephones, utilization of the fax machine and copier, and ensured the safety and security of the facility; contributed to the functionality of the facility by assisting the front desk personnel with duties including medical records and greeting clients.- Utilized the computer system and Medicaid Web based system to help determine a client’s eligibility based on qualifications provided during face-to-face interviews.- Consistently provided quality customer service to authorized patients in a culturally competent manner during personal encounters and telephone.- Expertly maintained confidentiality in accordance with the policies and procedures of the Health Insurance Portability and Accountability Act (HIPAA).- Completed and maintained monthly and quarterly reports, appointment reminder letters, and returned mail. Show less

Extensive coordination and execution of medical administrative support duties associated with aeromedical evacuation missions, while providing additional mission support to medical crews, ensuring patient movement and mission operation capabilities were maintained at productive and successful rate.- Maintained aeromedical mission board by meticulously keeping track of numerous aeromedical evacuation missions, ensuring 100% accuracy of over 200 missions and 1,800 patients within 2 month… Show more Extensive coordination and execution of medical administrative support duties associated with aeromedical evacuation missions, while providing additional mission support to medical crews, ensuring patient movement and mission operation capabilities were maintained at productive and successful rate.- Maintained aeromedical mission board by meticulously keeping track of numerous aeromedical evacuation missions, ensuring 100% accuracy of over 200 missions and 1,800 patients within 2 month period.- Initiated monthly medical record audits of each medical practice to ensure 100% compliance by medical staff when transcribing medical documentation. Complete travel documentations for medical administration of higher echelons.- Reviewed and submitted proper documentation for unit security clearances, remain abreast of requirements to remain alternate security manager. - Remained compliant with annual security training, medical record disposition, benefit analysis, and completing travel documentations for medical administration of higher echelons. Show less