Director Of Professional Services resume examples

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Skillful Director Of Professional Services resume

Patricia Casimir
Professional Summary

Health service administrator, versed in research and analysis. Seeking a position to develop and implement new and innovative health care improvement processes and admission procedures.

Education and Training
2012
Master: Management, Business ST Thomas University Miami, Fl

Management: Coursework: Behavioral Management, Business Ethics, International Seminar Economics, Managerial psychology, Human Resources (HR). Coursework in Public Health

2008
Certificate: Criminal Justice Adm Florida International University Miami, Fl

Certificate, CJA: coursework included: Analysis of Law Enforcement Operations, Criminology, and Business Law Administration. 2004 - 2008: Florida International University (FIU)

Certificate: Paralegal Miami Dade College

Paralegal: Coursework included: Legal Procedure, Business Law, Civil Litigation, Legal System, Contracts, Legal Research & Writing, and Criminal Law. Miami Dade College: Associate of Art

Diploma: General Miami Killian High School Miami Killian High School: General Diploma
Skill Highlights
  • Strong Medical Ethics
  • Records Management
  • Team building & Supervision
  • Electronic State Remissions
  • Provider Entrust Liaison
  • EDI transmission review healthcare related (837-P, 837-I)
  • Medical Terminology
  • Referral Coordinator
  • Meeting & Event Planning
  • Staffing management ability
  • Motivation techniques specialist
  • Confident public speaker
  • Government relations knowledge
  • Staff training and development
  • Personal and professional integrity
  • Claims analysis and review specialist
Accomplishments
Proven track record delivering outstanding results while monitoring projects
Professional Experience
01/2012 to Current
Provider Field Services Consultant HP Enterprise Services/AHCA Florida Medicaid Perform activities involving provider relations, enrollment, policy and medical review. Conduct audits to review accuracy of cost reports and payment of claims; Examine claims and reports to ensure proper compliance with State and Federal Regulations; Review inquiries from providers regarding cost report settlements; Review and analyze claim processing outcomes, identify issues and report as necessary, and proactively outreach to Supervisors, and providers; Conduct visits to Florida Medicaid provider locations for education and training; Create and deliver formal training, participate in webinars, and involve in other provider-related outreach; Prepare and analyze cost/business proposals and reports of findings, and make recommendations to top management; Apply knowledge of established procedures to research and resolve escalated providers questions or top management requests; perform claim researches, claim adjudication in FMMIS and EDI programs.
01/2008 to 01/2012
Social Service Coordinator/ Medicare Risk Adjuster Humana Inc Processed and identified potential Humana Medicare members who might be eligible for Medicaid; assisted members with states-specific enrollment process that includes: completing enrollment form, gathering and submitting appropriate supporting documentation required by each state, submitting and tracking the progress of the application with each state; responding to appeals (when applicable).
01/2008 to 01/2011
Provider Outreach Liaison Humana Inc Lead a team of Dual Eligibility Outreach Representatives in South Florida who mainly worked with providers; occasionally attended Providers events, churches, health fairs, and neighborhood organizations to promote Medicare Saving Programs (MSP); lead and provided strategic direction to existing partners regarding Medicare Savings services and its benefits. This was a hands-on management role requiring excellent leadership, communication, organizational, time management, oral presentation and operational skills. Demonstrated strong work ethics and great ability to lead.
01/2006 to 01/2008
Assistant Director of Professional Services Best Care Agency Inc Hallandale, FL Directed the Agency HR and Billing Departments in the absence of the Director. Provided leadership and motivation to all regular staff members and outside employee. Enforced job descriptions, policies and procedures. Oversaw many activities for professional services. Provided technical support to billing personnel; coordinated staff meeting and conference calls with State agencies and subcontractors.
01/2004 to 01/2008
Intake Coordinator Medical Data entry and Billing Entered Health Management information into computer and sending Oasis to the state. Responsible for all aspect of Medicare and Medicaid billing transmitted for payments. Provided administrative and analytical support for the strategic planning activities of billing. Intake Coordinator for patient care and HHA. Generated daily report for referrals. Handled client issues through written correspondence or via telephone interaction. Documented research and agreements in a clear, concise and professional manner.
01/2000 to 01/2002
Assistant Manager Miami Motors.com Miami, FL Performed initial consultation and evaluation on customer's credit; reviewed books for accuracy and discrepancies; responsible for account receivable and employee's payroll; ordered supplies and maintained inventory; handled various office duties including: typing, answering phones, filing etc.; served as intermediary between the client and the financing institution. Skills,
Certifications
  • Medical Terminology
  • HHA
  • Criminal Justice Administration Certificate, CJA: coursework included: Analysis of Law Enforcement Operations, Criminology, and Business Law Administration.
  • Legal Studies Certificate, Paralegal: Coursework included: Legal Procedure, Business Law, Civil Litigation, Legal System, Contracts, Legal Research & Writing, and Criminal Law.
  • Skills, Certificates and Languages:
  • Certified Concentration in Criminal Justice and International Business (STU, MS program)
  • Certified Paralegal (FIU, Legal Studies Program).
  • Certified Concentration in Latin American Studies (FIU, BS program).
Languages
Fluent in French, English, and Creole; average Fluent in French, English, and Creole; average in Fluent in French, English, and Creole; average in Spanish English, and Creole; average in Spanish
Affiliations
Volunteer and Internship Volunteer Feeding the poor (Haiti)
Presentations
Perform activities involving provider relations, enrollment, policy and medical review. Conduct audits to review accuracy of cost reports and payment of claims; Examine claims and reports to ensure proper compliance with State and Federal Regulations; Review inquiries from providers regarding cost report settlements; Review and analyze claim processing outcomes, identify issues and report as necessary, and proactively outreach to Supervisors, and providers; Conduct visits to Florida Medicaid provider locations for education and training; Create and deliver formal training, participate in webinars, and involve in other provider-related outreach; Prepare and analyze cost/business proposals and reports of findings, and make recommendations to top management; Apply knowledge of established procedures to research and resolve escalated providers questions or top management requests; perform claim researches, claim adjudication in FMMIS and EDI programs
Skills
Medicaid, Medicare, Billing, Documentation, Progress, Aspect, Correspondence, Hha, Oasis, Operations, Payments, Strategic Planning, Telephone, Audits, Claims, Cost Report, Edi, Federal Regulations, Field Services, Medical Review, Proposals, Settlements, Training, Hr, Benefits, Its, Liaison, Strategic Direction, Time Management, Account Receivable, Answering, Answering Phones, Credit, Filing, Inventory, Payroll, Typing, Assistant Director, Technical Support, Human Resources, Managerial, Event Planning, Healthcare, Healthcare Industry, Increase, Managed Care, Medical Terminology, Office Medical, Organizational Skills, Problem Solving, Problem-solving, Process Improvements, Records Management, Satisfaction, Snp, Solutions, Workflow, Associate, Contracts, Legal Research, Litigation, Paralegal
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