REGINA GULLO

Paducah,USA

Overview

years of professional experience

AETNA BETTER HEALTH OF KENTUCKY

05.2012 - Current

Have formed trusted relationships with provider network in 24 western Kentucky counties and the state of Indiana for Medicaid managed care product.
Act as liaison with hospitals, physician and behavioral health practices, chiropractors, home health and hospice agencies, therapy clinics, ambulance services, and DME companies to provide high level of customer service.
Research, resolve, and document complex provider inquiries regarding claims, enrollments, policies, contracts, and fee schedules.
Prepare and submit all enrollments for a large hospital system and review database uploading for accuracy.
Maintain strong relationships with key providers during migration of Coventry Health Care to Aetna Better Health by leading monthly partnership meetings which resulted in 100% provider retention in my region.

DAVID W. FRENCH, M.D., PSC

05.2011 - 05.2012

Managed transition of established fast-paced family medical practice from hospital ownership to private ownership while continuing to provide quality care for 150 adult and pediatric patients weekly.
Complete all enrollments with the major health care plans for physician and nurse practitioner and renew tax identification number.
Coordinate all county payables and receivables, billing collections, and payroll for 6 employees.
Triage patients prior to each provider visit by recording vital signs, weight, medications, and symptoms and obtain all pre-authorizations for diagnostic testing and medications.
Implemented safe e-prescribing to meet the 2011 and 2012 national compliance requirements of the Centers for Medicare & Medicaid Services.

MEDICAL ACCOUNTS RECEIVABLE SYSTEMS

02.2009 - 05.2011

Consulted medical providers, Medicare, Medicaid, commercial insurance carriers, and third-party administrators to complete enrollment applications for medical billing company.
Maintain professional and practice information on 250 clinicians across 60 practices in 8 states while serving as resource for clients, internal departments, and insurance representatives for plan participation status.
Made follow-up calls to payers to confirm status of credentialing, re-credentialing, and demographic changes.
Developed relationships with payer representatives in order to better facilitate the enrollment process.
Promoted to Team Lead for outstanding achievement by Director/Owner in less than nine months.

Eastern Kentucky University

Richmond, KY

Western Kentucky University

Bowling Green, KY

Computer: Microsoft Office 365 (Word, Excel, Outlook, SharePoint, Teams), QNXT, QuickBase, EncoderPro, Change Healthcare, Remedy, KYMMIS

Other: Integrity, dependability, written communication, prioritizing, active listening

12+ years experience in healthcare with unsurpassed organizational and documentation skills
Assessment, critical thinking and problem solving with a diverse population
Meeting tight deadlines while adapting to fluctuating situations and without sacrificing quality of work
Confident interface with all levels of management and work independently or collaboratively