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- Dynamic Leader who offers a background in SSI / Disability Application Processing, Medicaid Application Processing, Account Management, Case Management, Claims Resolution, Denials Appeals, and Workflow Prioritization; contributes talents in Nursing, Healthcare / Operations Management, Team Building, Training / Development, Strategic Analysis / Planning, and Process Optimization; and exhibits an ability to see the big picture at all times.
- Top Performer who makes decisions to reflect positively on claims processing in alignment with client needs and state / federal policy, and rises above challenges to streamline processes, improve efficiency, and drive winning outcomes.
- Excellent Communicator who builds and sustains synergistic relationships with healthcare professionals, insurance teams, multicultural workforce, stakeholders, patients / clients, and the community; who excels in both autonomous and collaborative work environments; and who leads staff by example and with integrity to achieve key objectives.
Capitalized on the opportunity to lead forward-thinking claims operations, including demonstrating knowledge of federal and state programs to benefit client coverage; assigning and supervising caseloads to Claims Processor and RAS staff; and managing deadline-oriented workflow, as well as monitoring quantity and quantity of claims taken.
Recruited, interviewed, hired, trained, and managed a top-performing workforce, including empowering staff to grow within the company, as well as mentoring staff and encouraging development opportunities to boost success.
Identified training needs and conducted training for all new claims processing staff.
Personally appealed numerous denials from SSA and Medicaid, and had denials overturned.
Led ongoing evaluations with staff and worked with District Manager on objective disciplinary actions.
Spearheaded implementation of new hospital facilities, and regularly attended state / federal agency meetings.
Supported trainer for resolution staff in development of Xxxxxx Medicaid and County Indigent Programs modules.
Interim Assistant District Manager
Applied strong leadership talents toward directing a solutions-oriented team of Healthcare Representatives at 3 S&W hospitals and 2 on-site Claims Processors, including collaborating with a District Manager to respond to policy issues.
Monitored quantity and quality of claims taken, and ensured claims were accurately submitted within a timely manner.
Drove healthcare success by recruiting, interviewing, and hiring a multicultural diverse workforce, including conducting thorough new staff training, monitoring attendance, and facilitating performance reviews and evaluations.
Liaised among District Manager and other departments to actively respond to various inquiries from key facilities.
Supported staff relocation when their contract was not renewed.
Expedited claims resolution by coordinating work with multiple teams.
Continued to work as Team Lead for 3 hospitals as Assistant District Manager.
Collaborated with Medicaid office onsite at both Hillcrest- and Temple-based locations.
Built strong relationships between Chamberlin Edmonds, patient, and hospital personnel.
Encouraged employees attendance and addressed issues related to tardiness and absenteeism.
Completed PCSR for S&W Temple for the hospitals and clinics, and reviewed PCSRs for accuracy.
Health Care Representative ￨ Team Leader
Strategically steered forward-thinking screening of patients for various state and federal programs, including SSI / Disability, State Medicaid Programs, Crime Victims Assistance, and Charity Programs, along with completing detailed SSI / Disability and State Medicaid Program applications and filing with the appropriate agencies to achieve goals.
Reviewed claims of team members prior to being submitted, reviewed No and Hold accounts and determined necessary action, and reviewed no accounts prior to being returned to the hospital to ensure seamless processes.
Proactively participated in weekly Parkland High Dollar meetings.
Planned and prioritized workflow among top Healthcare Representatives.
Monitored quantity and quality of claims taken, and ensured claims were submitted on time.
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Charge Nurse ￨ Hospital Supervisor
Utilized broad scope of industry knowledge toward delivering patient-focused care as a charge nurse and hospital supervisor, including managing patient care and staff assignments of a 45-bed facility while maintaining responsibility for all departments within the hospital and efficiently controlling beds with assignments of patients to correct units.
Developed individualized patient plans of care, along with reviewing physician orders to meet core patient objectives.
Developed a beneficial Pediatric Task Force in alignment with facility goals.
Served as Chairman of Pediatric Committee and Patients Fall / Safety Committee.
Trained as a Super User in Meditech and Siemens Hospital Information Systems.
Led quality-focused patient care within high-volume Med / Surg, PCU, Pediatrics, ED, and Post-Op Units, including performing in a charge nursing capacity in all patient care and nursing assignments and in review of physician orders.
Completed training on Meditech and Siemens Hospital Information Systems.
Played a vital role in working with severely handicapped and special needs children in their homes, including performing patient assessments, developing plans of care, and administering medications per patient needs.
Proactively educated family members and made referrals to additional agencies as required.
Collaborated with Medicare, Medicaid, and private insurance companies, as well as Area Agency on Aging and the Department of Adult Protection Agency, including documenting patient care and reporting wide-ranging challenges.
Conducted complete head-to-toe assessments and administered care while advising physicians of patient conditions.
Facilitated results-focused care ranging from administering IV antibiotics in the home, sterile dressing changes, lab draws, injections, patient or family education of complications, disease process, medication, and dietary teaching.
Audited charts and wrote recertification documents to ensure payment for key care.
Drove up to 125 miles daily to visit 5 8 patients and worked closely with area physicians and hospitals.
Successfully managed therapies in the home, including speech, occupational, and physical, as required.
Administrator ￨ Director of Nursing
Boosted healthcare success by recruiting, training, mentoring, and managing a team of 14 in caring for elderly and mentally ill residents, including ordering medications, providing injections, planning menus, and making rounds.
Regularly led drug and diet reviews to assure resident nutritional needs were met and medication administered.
Directed marketing and public relations initiatives, including print advertising, public speaking, and hospital visits.
Developed and adhered to the budget while maintaining a healthy cash flow.
Collaborated with the Missouri Division of Aging and Department of Mental Health.
Created detailed care plans after assessing each resident s needs both physical and mental.
Delivered comprehensive monthly in-service classes for public-sector division and departments.
Associate s Degree in Nursing Science (3.5 GPA) University of Arkansas Fort Smith
Extensive Studies Nursing ￨ Business University of Arkansas
Licensed Practical Nursing Degree Northwest Vo-Tech
Trauma Nurse Care Course ￨ Emergency Nurse Pediatric Course
Advanced Cardiac Life Support ￨ Basic Cardiac Life Support ￨ Licensed Nursing Home Administrator
Microsoft Office (Word, Excel, PowerPoint, Outlook) ￨ Meditech ￨ Siemens Hospital Information Systems
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