|Desired Industry: Accounting/Bookkeeping
|Desired Job Location: Carteret, New Jersey
||Date Posted: 11/2/2010
|Type of Position: Full-Time Permanent
||Availability Date: immediately
|Desired Wage: 35000
||U.S. Work Authorization: Yes
|Job Level: Management (Manager, Director)
||Willing to Travel: Yes, 25-50%
|Highest Degree Attained:
||Willing to Relocate: No
Visionary, innovative and performance-driven professional offering 15 years of progressive career in assuming various management and supervision roles. Demonstrated record of success in analyzing viability of business ideas, developing creative strategies to meet goals and ability in executing processes that significantly generate positive results on time, under budget, and beyond expectations. Recognized leader who is adept at setting goals, coordinating, developing and managing operations for clinical, financial/accounting, administrative, IT and HR activities.
- Known for excellent talent in leveraging efficiency, management and quality processes.
- Proven effective thinker; accustomed to fostering positive working environment and openly embraces diverse backgrounds and experiences.
- Proficient in using Microsoft Suite, WordPerfect, Call Tracking, Comtron System, Amisys System, iCare/ iView, ProClaim, QuickBooks Pro / Peachtree, Benefits Access, ICMS System, Power MHS, CIRF, ICD-CM/CPT Coding, and various medical office procedures.
- Bilingual in Spanish and English languages.
KAPITAL FREIGHT SOLUTION INC. ~ Avenel, NJ ~ 2006-2010
VIP OPTICAL LAB / PARTNERS IN VISION ~ Linden, NJ ~ 2005-2006
CUSTOMER SERVICE MANAGER
CIGNA HEALTHCARE ~ New Jersey, NJ ~ 2002-2005
PROVIDER DATA MANAGEMENT SENIOR ASSOCIATE - PENDED CLAIM UNIT
PROVIDER RELATIONS SENIOR ASSOCIATE – 16 States
STATE EXPERT (Ohio Network – 4 States)
HEALTH SERVICE SPECIALIST (3 States)
ADVANCED VISION CARE ~ North Bergen, Vernon, NJ ~ 1997-2001
OFFICE MANAGER (2 Sites)
ATLANTIC PACIFIC TEA COMPANY ~ New Jersey City, NJ ~ 1995-1997
DIPLOMA IN BUSINESS ADMINISTRATION AND COMPUTERIZED ACCOUNTING ~ 2002
HoHoKus Hackensack, School of Business and Medical Sciences (Formerly American Business Academy) ~ Hackensack, NJ
MEDICAL CLERICAL ASSISTANT CERTIFICATE ~ 1997
The Cittone Institute ~ New Jersey City
CORE COMPETENCIES :
- Business Development
- Organization/Multi-Project Management
- Persuasive Communicator
- Organization needs assessment/analysis
- Strategic and tactical planning
- HRIS technology
- Human Resource Systems Alignment
- Performance Assessment
- Project Management
- Business and Account Development
- Strategic / Financial Planning
- Customer needs assessment
SUMMARY OF EXPERIENCE
LEADERSHIP AND SUPERVISION
- Conducted effective customer service leadership programs through managing the Shipping Department and all the data entry processes.
- Managed the practitioners and vendor’s contract data entry into all CIGNA transactional platforms.
- Streamlined prior authorization process by handling all inbound phone calls.
- Sorted cases for approval, procedure status that needs prior authorization and performed case referral for clinical follow-up.
- Ensured the compliance of referrals medical authorization with the CIGNA HealthCare policies, procedures, documentation and requirements.
- Led the preparation of accounts payable and receivables for all locations.
- Supervised all reports and provided assistance to managers in performing various departmental functions
- Directed the provider’s claim submission and contracts review.
- Performed human resources functions, which include handling accounts payables/ receivables and department collections.
- Mentored providers on health plan products and facilitated application process for providers.
- Performed document verification for accurate insurance payments.
- Conducted cash reconciliation, credit and insurance payments.
- Handled the entire past due accounts and sustained all reports.
- Rendered training to newly hired employees.
COLLABORATION AND CUSTOMER RELATIONS
- Negotiated with matrix partners in regard to practitioner and vendor’s demographic and reimbursement set-up.
- Established and sustained harmonious business relationships with physician, providers and practice manager.
- Provided superior quality service to clients through continuous communication with provider on the company’s policies and procedures.
PROCESS CONCEPTUALIZATION AND IMPLEMENTATION
- Efficiently addressed complaint and issues that arose in each account to maintain the department’s positive workflow.
- Ensured and emphasized physician’s data’ quality, accuracy and efficiency within a complex database.
- Served as primary point of contract in claim research issue resolution.
- Efficiently resolved provider’s complaints and disputes; ascertained the adherence of all services with the company’s policies and procedures.
- Received, Certificate of Achievement ~ Health Services, Department of Recognition, 2003
- Received, Certificate of Achievement ~ Provider Resolution, Department of Recognition, 2004
Candidate Contact Information:
|JobSpider.com has chosen not to make contact information available on this page.
Click "Contact Candidate" to send this candidate a response.