Christina Riley
Greenwich,NJ
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Highly skilled and enthusiastic professional with more than 32 years of experience managing operations in patient-centric medical offices. Successfully oversee human resources, budgeting, supply management and patient services. Develop and lead productive and efficient office staff. Contribute to high-volume medical practices by providing exceptional customer service. Committed to maintaining high customer satisfaction by providing friendly, fast service for all needs. Skillful in researching and resolving billing discrepancies and claims. Disciplined and energetic professional well-versed in medical claim appeal processing, clinical relations, and medical billing.
Overview
32
32
years of professional experience
Work History
Provider Relations Representative
Atlantic Medical Imaging
Vineland
08.2019 - Current
- Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues
- Communicated effectively with clientele to maintain customer satisfaction and loyalty
- Answered providers questions and addressed problems and complaints in person and via phone.
- Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
- Gained strong leadership skills by managing projects from start to finish.
- Resolved problems, improved operations and provided exceptional service.
- Worked effectively in fast-paced environments.
- Worked flexible hours across night, weekend, and holiday shifts.
- Acted as a team leader in group projects, delegating tasks and providing feedback.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Verified eligibility and compliance with authorization requirements for service providers.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Checked documentation for accuracy and validity on updated systems.
- Developed and maintained productive working relationships with healthcare providers.
Physician Liaison
Center for Diagnostic Associates
Vineland
08.2010 - 08.2019
- Participated in weekly meetings to discuss ways to build the referral base and identify techniques that were not effective
- Scheduled appointments and met with providers and decision makers, engaging each to develop referrals.
Practice Manager
Arthritis & Rheumatology Assoc. of S.J.
Vineland
08.2008 - 08.2010
- Consulted with clinicians to develop business strategy
- Developed and implemented policies and procedures for the facility
- Motivated staff by offering direction and providing constructive feedback
- Ordered all supplies needed and kept tabs on inventory levels
- Created and implemented policies and procedures for effective practice management
- Supported the entire practice's staff, which boosted efficiency and improved the overall process flow.
Physcian Liason
Advance Radiology
Millville, NJ
06.2002 - 04.2008
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Attended meetings and seminars related to healthcare industry regulations and trends.
- Prepared correspondence for various departments concerning credentialing updates or requests for additional information.
- Provided details on building referrals and managed relationships with physicians.
- Engaged in professional networking to maintain strong relationships with communications and media professionals to drive partnerships and effective dissemination of mass communications.
- Increased revenues and supported business goals by developing public relations strategies and campaigns.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Filed and updated patient information and medical records.
- Delivered timely and accurate charge submissions.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Supported financial director with special projects and additional job duties.
- Evaluated and negotiated contracts to procure favorable financial terms.
- Utilized financial software to prepare consolidated financial statements.
- Prevented delays and claim denials by correcting information prior to submission.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Employed clinical and billing codes expertise to correct billing inconsistencies.
- Contributed knowledge to help improve financial management, billing and tracking systems.
- Analyzed and evaluated existing compensation and benefits programs and recommended improvements.
Credentialing Specialist
Booth Radiology
Woodbury Heights, NJ
07.2001 - 02.2002
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Maintained detailed records of provider data in the credentialing database system.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Conducted background checks on potential providers utilizing various resources including state licensing boards, OIG and GSA Exclusion List, NPDB.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Received and evaluated applications to look for missing and inaccurate information.
- Conducted primary source verifications such as background checks and board certifications.
- Provided professional services and support in a dynamic work environment.
- Developed and implemented onboarding and orientation programs for new employees.
Practice Manager
Surgical Associates of SJ
Millville, NJ
06.1999 - 07.2001
- Maintained financial records, including billing and accounts receivable and payable.
- Coordinated staff recruitment, training, and scheduling activities.
- Provided leadership and guidance to the medical team in order to meet goals and objectives.
- Monitored compliance with HIPAA regulations concerning patient privacy rights.
- Oversaw all aspects of day-to-day practice operations including front desk reception, appointment scheduling, billing and coding, insurance verification.
Practice Manager
Bridgeton Family Medicine
Bridgeton, NJ
02.1995 - 06.1999
- Maintained financial records, including billing and accounts receivable and payable.
- Coordinated staff recruitment, training, and scheduling activities.
- Assessed medical office operations, identified areas of improvement, and developed plans for corrective action.
- Monitored compliance with HIPAA regulations concerning patient privacy rights.
- Oversaw all aspects of day-to-day practice operations including front desk reception, appointment scheduling, billing and coding, insurance verification.
- Managed vendor relationships for supplies and services related to the practice.
Auto Claims Associate
State Farm
Pleasantville, NJ
02.1992 - 12.1994
- Reviewed and processed auto claims documents to ensure accuracy of information.
- Assessed the validity of claims and determined appropriate action based on policy provisions.
- Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
- Followed up with customers on unresolved issues.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Communicated verification and authorization status updates with PIP Claims department to facilitate decision-making for patient admissions and insurance coverage.
- Checked documentation for accuracy and validity on updated systems.
Education
Associate of Arts -
Cumberland County College
05.1990
Bachelor of Arts -
Thomas Edison State University
Trenton, NJSkills
- Staff training and motivation
- Relationship management
- Account development and networking
- Conflict management
- Human Resources Management
- Revenue Cycle Management
- Operations Management
- HIPAA Compliance
- Medical Billing
- Scheduling Coordination
- Policy and Procedure Development
- Bookkeeping
- Budget Oversight
- Managing Medical Practices
- Provider relationship management
- Provider orientations
- Fee exception negotiations
- Strategic Business Relationships
- Provider support
- Health plan operations
- Claims reviewing
- Interpreting physician orders
- Document filing
- Medical insurance
- Insurance verifying
- System updates
- Payment collection
Activities
- Member, Bridgeton Rotary Club
- Member, CompleteCare Foundation Board
- SERV Sexual Assault/Domestic Violence Advocate
- Volunteered for the White House Easter Egg Roll
- Previous Member of Off Broadstreet Players
References
References available upon request.
Timeline
Provider Relations Representative
Atlantic Medical Imaging
08.2019 - Current
Physician Liaison
Center for Diagnostic Associates
08.2010 - 08.2019
Practice Manager
Arthritis & Rheumatology Assoc. of S.J.
08.2008 - 08.2010
Physcian Liason
Advance Radiology
06.2002 - 04.2008
Credentialing Specialist
Booth Radiology
07.2001 - 02.2002
Practice Manager
Surgical Associates of SJ
06.1999 - 07.2001
Practice Manager
Bridgeton Family Medicine
02.1995 - 06.1999
Auto Claims Associate
State Farm
02.1992 - 12.1994
Associate of Arts -
Cumberland County College
Bachelor of Arts -
Thomas Edison State University
Similar Profiles
Susan BerckmanSusan Berckman
MRI Technologist at Atlantic Medical ImagingMRI Technologist at Atlantic Medical Imaging
Tami OsbornTami Osborn
Mammographer at Shore Medical Center/Atlantic Shore Imaging AssociatesMammographer at Shore Medical Center/Atlantic Shore Imaging Associates
Jaela MarshallJaela Marshall
Radiology Tech Aide/Receptionist Float at Atlantic Medical ImagingRadiology Tech Aide/Receptionist Float at Atlantic Medical Imaging
Casey ZicolelloCasey Zicolello
Front Desk Receptionist at Atlantic Medical ImagingFront Desk Receptionist at Atlantic Medical Imaging
PATRICIA SCHEMELIAPATRICIA SCHEMELIA
REGISTERED NURSE at Inspira Medical CenterREGISTERED NURSE at Inspira Medical Center