Gina Cacciatore
Aurora,CO
Summary
Enthusiastic and quick learning
Medical Billing Supervisor with
over 20 years’ experience with
strength in team leadership,
customer service, and
interpersonal relationships. 16
years revenue cycle management
(RCM), 11 years hospital
productivity, with electronic data
interchange (EDI) capabilities.
Overview
10
10
years of professional experience
Work History
Provider Network Cordinator
Colorado Access
Aurora , CO
06.2022 - Current
- Provider Recruitment and Contracting:Identifying, recruiting, and contracting new healthcare providers (such as doctors, specialists, and hospitals) to join the provider network.
Negotiating contracts and ensuring providers meet Colorado Access requirements and standards.
- Provider Relations and Support:Serving as the primary point of contact for healthcare providers within the network.
Addressing provider inquiries and resolving issues related to claims, billing, or service delivery.
Offering guidance on best practices, policies, and procedures to ensure smooth operations.
- Credentialing and Compliance:Ensuring that all providers within the network meet necessary credentialing requirements, including verifying licenses, certifications, and other necessary qualifications.
Monitoring compliance with healthcare regulations and Colorado Access policies.
Conducting audits and assessments to ensure adherence to standards.
- Network Management and Performance Monitoring:Managing provider performance, ensuring quality of care, and reviewing performance metrics.
Analyzing provider utilization and making recommendations to improve service delivery and cost efficiency.
Collaborating with quality improvement teams to implement initiatives to improve patient care.
- Claims and Billing Support:Assisting providers with claim submissions and resolving any claim-related issues or denials.
Educating providers about billing codes, reimbursement processes, and contract terms.
- Training and Education:Conducting training for new providers on the Colorado Access system, policies, and practices.
Educating current providers on new policies, procedures, and any changes in the healthcare landscape that affect the network.
- Data Management and Reporting:Maintaining accurate provider records and ensuring proper documentation in Colorado Access systems.
Generating reports on provider network performance, utilization, and compliance.
- Collaboration with Internal Teams:Working closely with other teams such as case management, member services, and IT to ensure a seamless healthcare experience for both providers and members.
Coordinating network changes, updates, or expansions with internal stakeholders.
- Conflict Resolution:Addressing any disputes or conflicts between providers, the organization, and members.
Mediating issues related to service delivery, payment, and compliance.
Credentialing Coordinator
Practice Health
Denver , CO
04.2021 - 06.2022
- Reviewed and processed applications to verify accuracy of credentialing information.
- Created and maintained records for all providers in accordance with the organization's standards.
- Monitored and tracked progress of credentialing applications to ensure timely completion.
- Responded to inquiries from internal and external sources regarding credentialing status.
- Maintained database of provider information, including contact details and licensure expiration dates.
- Collaborated with other organizations to obtain required documents for verification purposes.
- Assisted in preparing reports related to provider data and credentialing activities.
- Initiated contact with appropriate state boards and agencies as needed.
- Offered high level of assistance during managed care auditing process and conducted internal file audits.
Customer Service Executive
Blue Cross and Blue Shield
Aurora , CO
11.2019 - 04.2021
- Provided prompt and courteous service to customers via phone, email, and chat.
- Resolved customer complaints in a timely manner while maintaining professional attitude.
- Maintained accurate records of customer interactions, transactions and comments in the database system.
- Identified opportunities for process improvement within the customer service department.
- Collaborated with other departments to ensure customer satisfaction.
- Developed strong relationships with customers by providing knowledgeable advice on products and services.
- Provided technical support when necessary to resolve complex problems.
Billing Manager
Southeast Denver Pediatrics
Denver , CO
01.2015 - 08.2019
- Managerial tasks include but not limited to:
o Hiring, training, supervision, and performance evaluation of medical
practice billing staff
o Promote and encourage individual development for each team member
o Ensure day-to-day tasks are complete to remain in line with medical
practice compliance and financial goals
Medical billing tasks include but not limited to:
o Annual insurance contract review for 12 healthcare providers to ensure
compliance with the Health Insurance Portability and Accountability Act
(HIPAA)
o Revenue cycle management
o Monitor use of and regular updates to electronic medical records system
to ensure timely processing of outgoing claims
o Ensure accuracy of medical chart coding
o Ensure timely resolution of medical claims by monitoring all accounts
receivable
o Implement process improvement to maximize practice reimbursement
o Process daily, weekly, monthly, and annual accounts receivable reports
Additional responsibilities include but not limited to:
o Serve as a representative of Southeast Denver Pediatrics to participate in
and make recommendations to other community organizations such as
Colorado Children’s Healthcare Access Program and Medicaid.
o Acting Practice Manager as needed
o Marketing responsibilities inclusive of event planning and execution as
well as social media marketing.
Education
Massage Therapy - Massage Therapy
Denver School of Massage Therapy
Aurora, CO03-2005
Medical Billing - Medical
Community College of Aurora
Aurora, CO02-2004
Skills
- Network management
- System administration
- Customer support
- Verbal Communication
- Negotiation Skills
- Project Management
- Healthcare Knowledge
- Health Insurance System
- Contract Management
- Relationship Management
Timeline
Provider Network Cordinator
Colorado Access
06.2022 - Current
Credentialing Coordinator
Practice Health
04.2021 - 06.2022
Customer Service Executive
Blue Cross and Blue Shield
11.2019 - 04.2021
Billing Manager
Southeast Denver Pediatrics
01.2015 - 08.2019
Massage Therapy - Massage Therapy
Denver School of Massage Therapy
Medical Billing - Medical
Community College of Aurora
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