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Online Resumes with "Macess"
High energy versatile analytical thinker with strong interpersonal, communication and leadership skills. Conscientious, crwative and loyal
Tags for this Online Resume: Provider Relations, Managedcare, Credentialing, Provider Account Management, Provider Network Consultant, Training/Educatiing Physicians, Physician issue resolution, Training on network Policies , Macess, Recruitment
Tags for this Online Resume: Spanish, Microsoft Word, Excel, Access, PowerPoint, Outlook, Macess, Amisys, Transtracker, CCMS, Data Entry, Clerical, Call Center, Medical Office, Administrative, Training, Full Time, Permanent
I am a positive, ambitious, excellent problem solving, and self motivated person. I enjoy working with people and able to communicate effectively with all levels of personnel. I have excellent planning and organizational skills.
Audit Medical Claims, including errors from claims pricing, adjudication, adjustments, and bill issues. Conduct periodic post audit of claims to alleviate any incorrect decisions. Maintain a record of audit results Submit errors back to the proper source. Review, research, and resolve complex claims processing issues. Conduct audits of high dollar claims, staff, auditors, regulatory compliance audits, PDR audits and sp...
SUMMARY: Information Technology professional with more than eighteen years' experience in the healthcare domain. Expertise in Trizetto products, providing consultative services including but not limited to leading all aspects of Facets implementation, configuration, development and Manual/ Automated testing activities. Experienced with Trizetto's Facets 2.96 - 5.10. * Certified in Trizetto's NetworX Integrated and NetworX S...
Summary * Healthcare professional with 10 years of experience in Long Term Services & Supports. * Knowledge of Facets, Care Compass, Macess, Member 360 and excellent customer service skills. Positive reputation as a self-directed professional with superior problem solving, communication, and management skills & ICD 10 Codes. Auditing Charts for State Auditors. * Successful in managing time, prioritizing tasks, and organizin...
Summary * Healthcare professional with 10 years of experience in Long Term Services & Supports. Worked with geriatric members. * Knowledge of Facets, Care Compass, Macess, Member 360 and excellent customer service skills. Positive reputation as a self-directed professional with superior problem solving, communication, and management skills & ICD 10 Codes. Auditing Charts for State Auditors. * Successful in managing time, pr...
Twenty plus years' experience as a case manager and utilization management nurse. I have worked in this capacity in the acute care hospital, health plan, medical services organization and independent physician association settings. I am a proven leader due to management experience at the supervisor, manager and director levels. And direct patient care patient care experienced in acute care, subacute, inpatient acute rehabil...
Tags for this Online Resume: Management, Medical, Acute Care, Acute Rehabilitation, Applications, Benefits, Compliance, Medical Management, Utilization Management, Case Management, Retrospective clinical review, Prior Authorization, Concurrent Review, Virtual work at home, RN, Registered Nurse, Discharge Planning, Subacute, Long-Term Care