Heather Clark
Boise,ID
Summary
I have over 20+ years working in the Healthcare Industry from front/back office staff to payor support and payor program initiatives. With these jobs I have supported day-to-day program operations with expertise in contract management and resource coordination. Skillfully meet diverse needs and address issues to maintain efficiency and program outreach. Demonstrated success in building long-lasting relationships between internal and external stakeholders.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Medical Program Specialist - HCVC Program
State Of Idaho
01.2023 - Current
- Monitor contracts between State Department and Value Care Organizations (VCO)
- Provide monthly/quarterly data deliverables as set forth in contract details to VCO's
- Work closely with VCO representatives to help obtain deliverables from the VCOs
- Help host meetings that include communication with internal and external stakeholders
Medical Program Specialist - Healthy Connections
State Of Idaho
06.2013 - 12.2022
- Worked as the Region 3/4 Healthy Connections Representative for Primary Care Providers (PCPs)
- Contract monitoring between the State Department and Healthy Connections Service Locations.
- Conducted PCP visits to assist in contract requirements, and to assist in Quality Improvement Measures.
- Received incoming phone calls and member enrollment and inquiries.
- Worked alongside other professionals to outline and implement program plans and objectives.
- Built strong relationships with external partners to secure resources and support necessary for program success.
- Established a robust system for tracking and reporting on key performance indicators, allowing for a data-driven approach to program enhancements.
Quality Improvement Specialist - Health Home
State Of Idaho
10.2012 - 05.2013
- Worked with Pilot clinics to initiate a Patient Centered Medical Home (PCMH) approach.
- Helped pilot clinics and PCPs navigate in obtaining a National PCMH recognition
- Conducted comprehensive audits of manufacturing processes, ensuring adherence to quality standards and regulations.
- Implemented PDSA principles to optimize workflows, reducing cycle times and increasing productivity without sacrificing quality.
Medical Coding and Billing Specialist - Supervisor
Family Practice Physicians
01.2007 - 08.2012
- Worked as Back Office Supervisor - filling in for Office Manager when absent. Monitored staffing schedules, create and distribute pay checks, and cover for receptionist.
- Developed a comprehensive understanding of ICD-10-CM, CPT, and HCPCS codes to ensure proper use in medical coding assignments.
- Provided exceptional customer service to patients, addressing their concerns regarding insurance claims or billing issues with empathy and professionalism.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Maintained patient confidentiality by adhering to strict HIPAA regulations during all aspects of the coding and billing processes.
- Collaborated with healthcare providers to obtain necessary documentation for accurate code assignment and claim submission.
- Reduced errors in medical billings, effectively addressing discrepancies and rectifying issues promptly.
Pharmacy Technician
Fred Meyer Pharmacy
05.2005 - 08.2012
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Counted and labeled prescriptions with correct item and quantity.
- Assisted in maintaining a clean and organized work environment, ensuring compliance with safety regulations.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
Medical Corpsman
United States Coast Guard
06.1997 - 04.2005
- Conducted numerous and various job duties throughout my 8 year service to the Military.
- Worked 3 years in Search and Rescue, and then 5 years as a Medical Corpsman
- Worked in various Coast Guard clinics as a Pharmacy Technician for the whole Northwest, Laboratory technician, and general PCP/Acute care.
- Mentored newly assigned personnel on military protocol, unit-specific responsibilities, and various aspects of their role as Medical Corpsmen.
- Ensured compliance with all regulatory requirements, including HIPAA and other patient privacy guidelines.
- Facilitated timely patient discharges by coordinating necessary resources, such as home health services or durable medical equipment.
- Provided essential support during mass casualty events, efficiently triaging and treating injured individuals to save lives.
- Maintained accurate medical records, contributing to improved continuity of care for patients across multiple providers.
- Conducted regular training sessions for junior corpsmen to enhance their clinical skills and knowledge base.
Education
Master of Arts - Masters of Healthcare Administration & Management
University of Phoenix
Phoenix, AZ05.2013
Skills
- Skill Development
- Group and individual instruction
- Performance Assessments
- Project Management
- Program Management
- Office Administration
- Report Preparation
- Project Coordination
- Eligibility Determination
- Report creation
- Standard Operating Procedures
- Training Coordination
Certification
- Certified Pharmacy Technician, Fred Meyer - 2005-2012
- Certified Medical Coder, Contracted Military & Family Practice Physicians - 2005-2012
Timeline
Medical Program Specialist - HCVC Program
State Of Idaho
01.2023 - Current
Medical Program Specialist - Healthy Connections
State Of Idaho
06.2013 - 12.2022
Quality Improvement Specialist - Health Home
State Of Idaho
10.2012 - 05.2013
Medical Coding and Billing Specialist - Supervisor
Family Practice Physicians
01.2007 - 08.2012
Pharmacy Technician
Fred Meyer Pharmacy
05.2005 - 08.2012
Medical Corpsman
United States Coast Guard
06.1997 - 04.2005
Master of Arts - Masters of Healthcare Administration & Management
University of Phoenix
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