Bianca Fequiere
Quincy,MA
Summary
I want to utilize extensive contract experience and broad Healthcare knowledge, to continue in a Practice Manager role, or a full-time position in a manager role.
Healthcare Professional Credentialing & Contracting ~ Benefits ~ Insurance Processing ~ & Practice Manager Credentialing, Benefits Specialist, and now Practice Manager with broad knowledge in the healthcare industry. Prepare and coordinate provider information to / from managed care quality committees and other internal departments and / or external entities. Exceeded production goals by 99% while maintaining quality. Maintained credentialing database while tracking all direct provider contract data. Performed primary and secondary source verifications of credentials according to departmental policy. Maintained all medical license, Drug Administration and malpractice insurance for physicians and mid-level providers. Ensured compliance with national standards of quality organizations. Organized Operations Support Staff verifies orders and coordinates fulfillment services to support operational efficiency. Fosters collaborative team environment to drive positive customer experiences. Proficient with office machinery and leverages strong multi-tasking skills to meet deadlines by prioritizing assignments.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Operations & Support Specialist
AMI
08.2023 - Current
- Greet and assist visitors, ensuring they adhere to the shelter policies and procedures
- Register visitors, maintain accurate records, and issue visitor badges or passes as required
- Monitor visitor activities to promote safety, security and compliance with shelter guidelines
- Provide meal distribution ensuring visitors receive appropriate meals and dietary accommodations
- Collaborate with shelter staff to ensure a safe, clean and organized environment for residents and staff
- Assist in implementing and enforcing shelter policies and regulations.
Transplant Financial Charge Coordinator (contract)
Boston Medical Center
09.2021 - 05.2023
- Verified authorizations, confirmed primary and secondary payers, and identified which contract/plan will provide payment for all planned phases of care
- Requested authorizations for planned services and submitted clinical justification as required under the direction for transplant clinical team
- Obtained reauthorizations as necessary
- Updated the clinical administrators and operation manager weekly regarding all financial issues and authorization statuses
- Worked with BMC finance department to ensure all Medicare Cost Report data is accurately interpreted
- Oversee all transplant related charges
- Communicated with billing providers to ensure proper coding
- Met with department leaders to report status and progress of financial planning process for donor and recipients, and addressed any outstanding issues
- Monitored financial situation of all kidney recipients, post-transplant for up to 24 months, and coordinated insurance and/or benefits adjustments.
Practice Manager (contract)
Harvard Medical School/BIDMC
07.2019 - 09.2021
- Coordinated treatment teams with physicians and nursing staff regarding patient’s care
- Managed phone center with high volume calls averaging 12000+ calls per month scheduling appointments per phone schedulers
- Assisted in clinical and non-clinical research studies from study start up through study closure collaboration with internal research staffs and study teams
- Credentialed new resident physicians and existing physicians with all health plans and hospitals
- Tracked and maintained all records
- Oriented new physicians to the practice
- Responsible for all aspects of hiring, including recruitment, salary and benefits, job evaluation, training and development, and performance management
- Responsible for obtaining, renewing, and maintaining records for physicians' and nurse practitioners' federal and state licensures and insurances
- Managed all staff and physician time off request and ensured practice has adequate coverage and appropriate communication is disseminated related to coverage.
Credentialing Specialist (contract)
Change Healthcare
03.2017 - 07.2019
- Efficiently credentialed all initial and reappointed applicants
- Verified the professional licensing, training and certification of professional medical staff to ensure healthcare professional complied with all establish regulations and guidelines
- Maintained all medical license, drug administration and malpractice insurance for physicians and mid-level providers
- Maintained appropriate CME requirements for each state license for individual physicians
- Verified State licenses, Board Certificated using the National Practitioner Data Bank Report, online verification of medical licenses, of State Medical Board, Uniform License Application.
Office Manager of Mental Health
Walker Community Counseling
05.2017 - 10.2018
- Organized and prioritized office tasks to fulfill all administrative requirements
- Aided human resource to recruit/train new and existing staff for a position
- Administer and compiled weekly and monthly performance data
- Approved timesheets and time off for clinician’s onsite and school base
- Maintained all office equipment, files and recorded for effective functioning of the office
- Entered client’s insurance and verify authorizations in online medical record
- Managed front desk duties including checking in clients, answering phones, and collecting fees
- Assisted with scheduling clinical appointments for about 10 clinicians on site and appointment reminders
- Established and monitor the office filing system to assure information is organized, complete, and adheres to DPH guidelines.
Benefits Systems Analyst (contract)
Tufts Health Plan
11.2014 - 03.2017
- Configured benefit system for new and renewing employer groups
- Updated all benefit system screens and create new or modify existing benefit codes and rules to configure benefit system based on information from the ECS database form and the Benefit Checklist (for SI employer groups)
- Created new/modified existing benefit categories for web display
- Ensured all benefits were outlined within ECS (and/or Benefit Checklist), requesting and securing change forms
- Maintained and enhanced the benefit documentation system for SI (as assigned) and FI Large Groups.
Advocate
Rosie’s Place
08.2010 - 08.2015
- Supported and provided assistance to guests to help meet housing, emergency shelter, transportation, food access and clothing needs
- Provided information and referrals to guests for services offered on-site by both Rosie’s Place program and other allied agencies
- Supported guests by helping to meet their needs as individually identified by them
- Encouraged self-sufficiency, responsibility and independence
- Maintained high level of knowledge about current guests and ensured confidentiality when handling all aspect of guest’s information
- Maintained accurate guest records in database to track guest support
- Participated in weekly supervision, program meetings and monthly staff meetings
- Intervened in guests’ crises and emergencies in a dignified and respectful manner.
Education
Certificate - Information Technology
Massasoit Community College
Brockton, MA12.2020
Bachelor of Healthcare Administration -
Fisher College
Boston, MA05.2012
Skills
- Office Suites: Office 2010-2019, & Office 365
- Messaging: Outlook, & Teams
- Healthcare Systems: Epic, NPDB, ECS Database, Trizetto, TAPH Master
- Scheduling
- Workflow Streamlining
- Expense Reporting
- Operations Tracking
- Logistics Coordination
- Program Evaluation
Certification
· IT Essentials: PC Hardware and Software
· Coursera Google IT Support
· Coursera Google IT Security: Defense against the digital dark arts
· Coursera Google Operating Systems and you: Becoming a Power User
· Coursera Google System Administration and IT Infrastructure Services
· Coursera Google The Bits and Bytes of Computer Networking
· Coursera Google Technical Support Fundamentals
Timeline
Operations & Support Specialist
AMI
08.2023 - Current
Transplant Financial Charge Coordinator (contract)
Boston Medical Center
09.2021 - 05.2023
Practice Manager (contract)
Harvard Medical School/BIDMC
07.2019 - 09.2021
Office Manager of Mental Health
Walker Community Counseling
05.2017 - 10.2018
Credentialing Specialist (contract)
Change Healthcare
03.2017 - 07.2019
Benefits Systems Analyst (contract)
Tufts Health Plan
11.2014 - 03.2017
Advocate
Rosie’s Place
08.2010 - 08.2015
Certificate - Information Technology
Massasoit Community College
Bachelor of Healthcare Administration -
Fisher College
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