Community Health Choices

Conduct interviews with key business users to collect information on business processes and user requirements.Document business processes and analyze procedures to see that they would meet changing business needs.Assess the impact of current business processes on users and stakeholders.Identify process inefficiencies through gap analysis.Plan and coordinate logistics and materials for team and stakeholder meetings Works as a liaison among Vendors and Stakeholders in order to elicit, analyze, communicate and validate requirements for changes to business processes, policies and information systems.Use continuous improvement tools to evaluate and prioritize process improvement projects Determines current state processes at a Site and Enterprise level for the purposes of identifying best practicesSupervise services provided by the vendorPerforms post monitoring for all process changes and/or new business implementationPrepares detailed trend analysis reportsCoordinate with other team members to achieve assigned goalsUpdate and maintain database for dashboard reporting.

Problem identification and resolution. Resolve, track, report, and internally coordinate issues that providers have encountered, including but not limited to claims issues. Check claim and authorization statusWork with internal staff to assist in identification, tracking, communication and escalation of systematic/network wide claims issues.Identify inappropriate coding trends or issues resulting in payment errors and identify appropriate communications to address claims rejections and denials based on claims data.Serve as liaison with assigned provider network to support key internal business functions such as directory development/accurate provider data, contract/compliance oversight, claims payment and customer service activities.Work closely with team lead and supervisor on special pojects for various providersAssist team lead with responding to service forms to assist with educating other representatives.

Verify patient insurance for eligibility and benefitsPatient registration for multi-specialty practicePatient checkout (schedule return appointments and give copies of their visits), schedule appointments for testing procedures (thyroid biopsies, EKGs, Exercise Stress Test, INR Checks, Stress Echocardiograms, and EchocardiogramsEdit transactions to ensure clean claims were submitted to insurance companiesAssists medical records in records requestsObtain and input referralsCalculate and making end of the day deposits Use Allscripts to scan medical records into patients filesCopayment collection (cash, check, and credit)Task and instant message providers and other employees for patient assistance

Created, implemented and overseen daily policies and procedures for employees to followRecruited, hired, scheduled, supervised and motivated 3 staff members and 2 externsCoordinated with Chiropractor to insure patients were adherent to their treatment plansTrained staff to enhance customer serviceUse of QuickBooks for bookkeeping and paying of all expensesProblem solved any issues of the staff and patientsMaintained and operated the electronic health records and billing system using Eclipse software for personal injury, workers compensation and slip/fall cases. Maintained a check on all office equipment and facilitated repair or replacement of all malfunctioning equipmentManaged insurance and billing related procedures including insurance verification and collections

Problem identification and resolution. Resolve, track, report, and internally coordinate issues that providers have encountered, including but not limited to claims issues. Update referrals and verify insurance via Streamline DatabaseCheck claim and authorization statusWork with internal staff to assist in identification, tracking, communication and escalation of systematic/network wide claims issues.Identify inappropriate coding trends or issues resulting in payment errors and identify appropriate communications to address claims rejections and denials based on claims data.

Assistant to ChiropractorAnswer telephonesScheduling appointmentsPurchased supplies as neededIn charge of accounts receivable (cash, check, credit cards and money orders), also upload payment information detail from remittance advices receivedDistributing incoming mail and also in charge of outgoing mailVerifying insurances via telephone and NavinetProvided customer ServicePerform electronic and paper claimsEnter patient data using the Eclipse DatabaseSubmitted electronic and paper claims to varous commercial and automotive insurance carriers.