Sapiens

Senior Business Analyst

Optum

•	Revenue cycle assessments for: hospitals, health systems, physician groups, diagnostic laboratories
•	Revenue cycle process improvement 
•	Alignment and implementation of client/partner processes and Optum360 technology
•	Revenue cycle improvement / redesign
•	Identify client/partner accomplishments barriers in achieving operational excellence 
•	Understand client/partner business metrics and results 
•	Evaluate and analyze client/partner data to understand trends in all areas of the operation 
•	Development of options and recommendations for client/partner improvement 
•	Understand and represent Optum360 technology and services and how they will improve client/partner operations 
•	Work w/ Healthcare partners to optimize RCM operations from Point of Service, Optimizations and Operations. 
•	Results driven projects to deliver outcomes and decrease denials and increase revenue
•	Provide overview of staffing needs and provide staffing solutions

Target

Guest Services

Ohio BWC (Official)

•	Supervision of up to 14 FTE direct reports within the Bureau of Workers Compensation
•	Management of daily operations of medical claim processing and subsequent determinations
•	Generates reports on missed opportunities and reviews date to leadership 
•	Works collaboratively with third party administrators, internal and external business partners
•	Manages operational improvement by development of workflow processes for increased productivity          
•	Participates in monthly meetings with department leadership to review KPIs, Operations and Performance
•	Collaborates with clients to ensure consistent communication and reporting (i.e.: Attorneys, employers, etc.)
•	Assists with implementing BWC laws, policies and procedures. (i.e.: Coverage, Exposure and Denials)
•	Conducts year around quality assurance and monitors productivity metrics to report to leadership 
•	Completes audits on quality, productivity and errors of performance 
•	Responsible for all aspects of staff development to include hiring, training, coaching and development

Supervisor - Medical Claims Specialists

•	Perform initial claims investigation & determination within prescribed timeframes
•	Complete investigation during initial claim development
•	Explain BWC laws, policies, procedures, & processes to BWC customers, employers and third parties
•	Initial and ongoing point of contact to internal and external business partners for the duration of the claim.
•	Point of contact for all written and telephonic correspondence regarding the claim.
•	Ensures business is compliant with state specific Workers’ Compensation regulations
•	Ensures confidentiality of Workers’ Compensation claims records; including relevant health information
•	Make claim allowance decisions based on the evidence within the intent of the law &/or BWC policy
•	Issue orders by making initial & subsequent decisions based on the evidence in the claim
•	Process medical & legal documents within prescribed timeframes
•	Perform special assignments related to claims processing
•	Review medical documentation, legal documentation and take appropriate action

Claims Service Specialist

•	Identify and handle a variety of routine to complex customer calls or prospect inquiries or requests
•	Educate members about their coverage benefits and services and directing them toward available resources
•	Point of contact for all written, telephonic, live chat or faxed correspondence regarding the claim. 
•	Handles 1600-2000 incoming calls from customers regarding claims for processing
•	Provided information assistance to injured workers and employers
•	Meet Employee Service Representative goals for customer satisfaction, quality, productivity, and performance
•	Ensure all HIPAA and state privacy and confidentiality requirements/regulations are adhered to at all times
•	Responded verbally or in writing to customer inquiries within a prompt amount of time
•	Provided technical assistance concerning use/navigation of website for customer satisfaction
•	Explained BWC policies and procedures to customers

Employer Service Representative

Huntington National Bank

♣	Performed teller transactions and money handling.
♣	Opened new accounts (checking, savings, loans, credit cards)
♣	Provided Customer service (answer phones, in-person)
♣	Exceeded sales, accounts and customer service goals

Store Banking Specialist

The Ohio State University

Greeted members for accurate membership check-in process for entrance into the facility
• Provided customer service by directing patrons to room locations and giving tours
• Promoted safe and courteous behavior while enforcing facility regulations
• Supervised locker rooms and equipment checkout areas
• Provided safety, security, and customer service of patrons

Member Services Representative

The Ohio State University Wexner Medical Center

Performs registration, admission, scheduling, financial assistance and insurance verification functions
• Management of day-to-day tasks; staffing, scheduling, training, and co-pay collection
• Complete Patient Access in areas of Ob/Gyn, Main Admitting, Emergency and Call Center
• Completed Pre-Registration process for scheduled arrivals and hospital transfers
•   Collection of accurate identification and selection of insurance carrier in the patient medical record
• Determines patient financial responsibilities, performs revenue collection and charge entry
• Provides administrative support working as a liaison between patients and medical staff
• Collection of accurate and quality data which includes financial and clinical information
• Prepare statistical and narrative reports from Epic and complete EPIC workques
• Completes Registration functions for Emergency, Inpatient, Outpatient and Ambulatory services
• Works closely with Hospital Administrators, House Supervisors, ED, Charge RNs and ancillary  
• Serves as a primary liaison between patient access services and 3 vital entities
• Provides administrative support working as a liaison between patients and medical staff

Patient Access Representative - Hospital Revenue Cycle

To use, develop and acquire the skills necessary to succeed in my career ambitions.

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