Determining eligibility of provider based on CMS guidelines
Research provider demographics in PECOS, follow CMS audit process/guidelines regarding compliance of Medicare Debt and billing practices and encounters
Asses risk level and in depth screening of provider to ensure excluded providers are eliminated from Medicard Review board
Studying statutes, rules, policy manual and clarifications
Attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge
Customer Service Representative 2
AHCCCS
05.2021 - 01.2022
Helps providers by identifying and providing services and solutions to their questions regarding renewals, coverage, eligibility, billing, and policy changes
Delivers expertise by identifying and analyzing provider needs to ensure high satisfaction, growth and retention of business
Upholds our providers care standards by achieving individual goals on call quality, handle time, lead transfer ratio, adherence, first call resolution, and reliability
Maintains and tracks accurate data in various computer systems
Executive Administrative Assistant
AHCCCS
07.2018 - 05.2021
Performs extensive document creation/editing and preparing expense report submissions
Meeting logistics and preparation, providing detailed data, information and resources to leader and participants
Handle all personnel and confidential company materials with sensitivity, discretion and with a strong risk lens
Regularly strategizes, consults, and executes on several assignments/projects
Education
Bachelor of Arts - English (Literature)
Arizona State University
Tempe, AZ
06.2015
Skills
Understanding of AHCCCS Provider Enrollment Portal (APEP)
Understanding of rules and regulations relating to the determination eligibility to become an AHCCCS provider
Capability to listen, comprehend and offer advice to questions surrounding Medicaid enrollment
Organizes, updates, and files department’s forms, notes and archival data
Microsoft Office (Excel, Outlook, Word, Publisher, Project, PowerPoint, Access) knowledge