Rachel Dueno
Staten Island,NY
Summary
Motivated professional offering 20+ years of experience in the Healthcare Industry who would add value to any organization in need of great collaboration, interpersonal and multitasking abilities. Exceptional customer service, Meets tight deadlines.
Overview
18
18
years of professional experience
Work History
FGP Senior Associate
NYU Langone Medical Center-Dept of Radiology
05.2012 - Current
- Process all incoming Radiology imagining scheduling calls promptly and efficiently in a professional manner.
- Schedule all routine imaging appointments and follow ups for visits and procedures.
- Answer 85-100 calls per shift to assist with Patients questions and concerns.
- Complete and/or review all required demographic and insurance registration data during scheduling process in order to ensure accuracy.
- Maintain and/or assure all clinical data provided in EPIC for in house orders and outside orders are all pertinent information before assigning an appointment to ensure accurate scheduling.
- Maintain and resolve patient records with missing information in the Reservationist WQ to monitor for accuracy and completeness.
- Manage cooperative and professional relationships with physicians, nurses and office and clinical staff.
- Adhere guidance and/or train less senior staff with completing intake related duties.
- Provide excellent patient care satisfaction and ensure understanding.
- Work successfully with a diverse group of coworkers to accomplish goals and address issues related to our unit.
- Demonstrate leadership by making improvements to the work processes and helping to train others.
Senior Provider Relations Representative
Amida Care
02.2010 - 09.2011
- Established provider education, contractual agreements with physicians and multi-specialty providers.
- Strong knowledge of Provider and Ancillary Credentialing and Recruitment process.
- Negotiated, prepare and review contracts.
- Conducted new provider orientation.
- Create and maintain effective working relationships with network providers to ensure maximum compliance.
- Troubleshoot issues raised by provider and non-compliant providers; communicate with management and propose remedy.
- Received and resolve member complaints; communicate with external and internal sources for resolution.
- Performed on-site visits to participating providers to offer continued education and training to providers and administrative staff.
- Acted as liaison between delegated hospitals, clinics, clinicians, executive and administrative staff.
- Performed internal audits on provider credentialing files for IPRO and DOH survey.
- Processed initial credentialing and re-credentialing applications utilizing NCQA guidelines.
- Ensured compliance with regards to HIPPA, NCQA, DOH, and other city, state and federal guidelines
Provider Relations Representative
New York-Presbyterian Community Health Plan
08.2006 - 07.2009
- Provided outreach and guidance to providers and potential providers regarding benefit and enrollment questions, and/or providing assistance on any social services concerns.
- Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues.
- Supported growth of network by efficiently handling higher volumes of calls.
- Eliminated contractual risks by instructing providers and coordinating educational material distribution.
- Enhanced client satisfaction ratings by resolving disputes and partnering with healthcare providers to clarify issues.
- Participated in audit processes to ensure quality management accreditation.
- Assisted providers with inquires regarding missing payments, reissuing checks and/or contract rates.
- Maintained and updated over 6,500 provider data base to administered data clean up process.
- Managed provider data base batching for state projects such as IPRO and Article 44.
- Investigated member complaints toward providers
Lead projects while supervising over other employees. - Produce weekly/monthly/quarterly and annual reports (e.g., QARR, IPRO, Article 44, HEDIS, HPN) and departmental metrics for system updates and health plan directory.
- Facilitated professional communication between patients, medical administrative staff and regulatory agencies.
Education
High School Diploma -
Bishop Loughlin HS
06.1990
Skills
- Verbal and Written Communication
- Creative Problem Solving
- Team Supervision
- Verbal and Written Communication
- Computer Skills
- Oral Communication
- Attention to Detail
- Resolving Problems
- Relationship Management
- Organized and Efficient
- Bilingual in Spanish and English
- Medical Terminology
- Punctual and Hardworking
- Organized and Detail-Oriented
- Proficient in Microsoft office Word, excel, powerpoint
Languages
Spanish
Professional Working
Timeline
FGP Senior Associate
NYU Langone Medical Center-Dept of Radiology
05.2012 - Current
Senior Provider Relations Representative
Amida Care
02.2010 - 09.2011
Provider Relations Representative
New York-Presbyterian Community Health Plan
08.2006 - 07.2009
High School Diploma -
Bishop Loughlin HS
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