Carmen Pimentel
Schenectady,NY
Summary
Experienced Office Management and Administration Professional experienced optimizing productivity, efficiency and service quality across various environments. Highly dependable, ethical and reliable support specialist and leader that blends advanced organizational, technical and business acumen. Works effectively with cross-functional teams in ensuring operational and service excellence.
Overview
25
25
years of professional experience
Work History
Administrative Support Coordinator
Personify Health
Fresno
01.2022 - Current
- Monitor flow of electronic data files
- Research provider inquiries via email, chat and company website
- Develop and review production reports.
Healthcare Program Associate
New York State Department of Health: Medicaid Center of Excellence
Albany
01.2018 - 01.2022
- Supervised a team responsible for over $165M in Medicaid cost savings for New York State in 2018
- Developed new processes for claim review for new and established staff to reduce reviewer error
- Provided training and development to subordinates both at time of hire as well as ongoing development.
Healthcare Organizational Operations Administrator
New York State Department of Health: Provider Enrollment
Albany
01.2017 - 01.2018
- Processed enrollment applications from both billable and non-billable providers
- Drafted approval notices and requests for further information
- Performed Complex database reviews to ensure provider eligibility prior to enrollment.
Provider Customer Service Representative
Beacon Health Options
Latham
01.2016 - 01.2017
- Provided accurate information regarding behavioral health benefits and eligibility to providers
- Researched provider inquiries regarding benefits
- Collaborated with other departments to resolve provider issues in a timely and efficient manner.
Claims Auditor
New York State Department of Health
Albany
01.2013 - 01.2016
- Reviewed health insurance claims from medical professionals and processed appropriate reimbursement
- Ensured agency quality assurance protocols were met by continuously collaborating with internal departments
- Provided technical assistance to providers regarding claim denials according to Medicaid policy.
Medicaid Support Specialist
New York State Department of Health
Albany
01.1999 - 01.2011
- Researched and tracked reimbursement for services by participating Medicaid providers
- Educated and interpreted Medicaid policy for providers for the purposes of solving claim issues
- Assisted Medicaid beneficiaries to obtain approved providers.
Education
Associates of Applied Science - Paralegal Studies
Schenectady County Community College
Schenectady, NY01.2003
Skills
- Leadership and Supervision
- Program Development
- Claims Processing and Review
- Diverse Personnel Management
- Provider Relations
- Customer Service
Timeline
Administrative Support Coordinator
Personify Health
01.2022 - Current
Healthcare Program Associate
New York State Department of Health: Medicaid Center of Excellence
01.2018 - 01.2022
Healthcare Organizational Operations Administrator
New York State Department of Health: Provider Enrollment
01.2017 - 01.2018
Provider Customer Service Representative
Beacon Health Options
01.2016 - 01.2017
Claims Auditor
New York State Department of Health
01.2013 - 01.2016
Medicaid Support Specialist
New York State Department of Health
01.1999 - 01.2011
Associates of Applied Science - Paralegal Studies
Schenectady County Community College