(999) 999-9999 Home
(999) 999-9999 Cell
999 Main Street, Any town, NY – 99999 email@example.com
years of experience in the medical field working with physicians, hospitals, pharmacies, and facilities to provide affordable and predictable products and services for customers and business partners.
- Contracting; Physicians & Hospitals
- Credentialing and Maintain CAQH
- Billing and Collections Administration
- Hospice, PFT, Sleep Studies, Hospital, Family Practice, DME, and more Billing, Collections, AR (1500 HCFA, UB-92 forms) CPT and ICD-9
- Approval and Denial of claims
- Policies and Procedures HIPAA
- ACR, NCQA, and JCAHO requirements and accreditations
- Contract Renegotiations
- Reimbursement Rate Negotiations
- Government Enrollments, Medicare, Medi-Cal and Medicaid
- Team player
- Strong interpersonal skills
- Supervisory experience
- Excellent communication, written and verbal
- Strong problem solving skills
- Very Organized
- Extensive Knowledge of numerous computer systems [i.e., Zotec, NextGen, Cal Med, Medi-Soft, Mysis, MS Office applications and more]
ABC Inc., Any town, NY
- Evaluate and negotiate contracts in compliance with company contract templates & reimbursement structure standards.
- Responsible for network development, provider contracting models, reimbursement methodologies, & financial analysis.
- Possess knowledge of managed care, Medi-Cal, Healthy Families and Medicare lines of business.
- Work closely with Utilization Management to ensure the process for prior authorizations while negotiating Letters of Agreements.
- Establishes and maintains strong business relationships with Hospitals, PCPs, Specialists, Medical , and Ancillary providers.
XYZ Corp., Any town, NY
Paralegal and Contract Specialist
- Perform front-end support in the form of administering moderately complex contracts and agreements including interpretation of contract requirements, contract administration, risk management, change management, conflict resolution, delivery and payment for products and services with a wide degree of creative solutions.
- Establish professional networks and rapport to facilitate company objectives and internal and external customer satisfaction.
- Participate in negotiations on contracting matters with internal associates + external clients as needed generating revenue and contributing to team success.
- Perform back-end contract administration processing for client-signed contracts in the form of reviewing criteria for contractual obligation, requirements, risk management, change management, conflict resolution, delivery and payment for products and services; capturing sales reporting and commissionable revenue data, and forwarding contracts for final execution processing and archival.
- For front-end and back-end support I facilitate alignment with existing operating procedures by internal partners (sales, product management, and billing, et al.) by reviewing and discussing contract issues and obtaining appropriate management approval as required.
BCD Inc., Any town, NY
- Manage schedules, record necessary revenue accruals and deferrals, and reconcile revenue and deferred revenue to the general ledger on behalf of all international entities, maintained in local currencies.
- Work closely with Sales, Legal, and Sales Operations in contract negotiation and preparation to ensure compliance with GAAP accounting guidelines to appropriately recognize revenue.
- Played Critical role as Administrator in planning and implementation of Softrax as primary instrument for revenue recognition, billing, cash applications and customer database.
- Developed + Implemented contract numbering process for tighter internal controls and more efficient tracking process during quarterly and year-end internal and external audits; PWC year-end audit adjustments fell from 100+ in 2002 to 0 in 2004; 0 adjustments through Q3 2005.
- Assumed leadership position by training, coaching, and mentoring new team members in both Finance and Sales.
- Surpassed annual quota of $500k, finishing FY at 105%; led team in new customer acquisition with 20 net new customers.
- Key contributor to Inside Sales team growth by assisting in interview and candidate selection process, with team surpassing $1.5M in first year.
I amenrolled in college courses to obtain my degree
1998 New York High School New York, NY
References are available upon request.