MEDICARE - 6 YEARS EXPERIENCE

I have specialized experience which includes: experience managing, directing, overseeing or performing work concerned with the administration and operation of health insurance programs in the Medicare field. Extensive knowledge with the interpretation of health insurance program requirements and formulating policies. Have the ability to create methods, and procedures; monitoring, reviewing, evaluating and assessing the integrity and quality of health insurance program operations. Can prepare and analyze health care data to relate to health insurance programs. Health care research in evaluating proposals to support the development, implementation and refinement of health insurance payment and delivery systems. Proficient knowledge in regulations related to Cost, Medicare Advantage and PDP Plan. Maintained a 100% in areas of enrollment, Low Income Subsidy Match. Prescription Drug Errors (PDE) was at 5% and was reported as the lowest in the nation. Have the ability to maintain Continuation of Benefits for members. I have created a program to automatically send and receive files from Medicare. Have the ability to work directly with Medicare to ensure activity with reporting is accurate to the standards of Medicare. Completely understand the rules and regulations of Medicare. Specialized knowledge in Amisys: Billing Configuration - Certified Membership Configuration – Certified Indemnity - Billing Configuration – Certified Benefit Configuration – Certified Experience to conduct system analysis to work with programmers to meet the end-user needs Serve as a liaison between end-user and programming staff Specialized areas: Project Management Compliance specialist Customer Service Marketing Creating a Medicare shop Consulting I possess excellent interpersonal skills confident and poised in interactions with individuals at all levels. Expert technical skills and extensive knowledge of IT. Develop team structures and create focused and engaged groups Extensive experience in management consulting.

Medical Office Manager

Temple, TX