Sascha Roman
Operations Specialist
Austin,TX
Summary
Team Leader experienced in directing activities in any work setting. Talented at developing strategies, setting goals and training employees. Confident and decisive when communicating goals and vision to succeed. First-class problem solver with excellent interpersonal skills.
Overview
14
14
years of professional experience
4
4
years of post-secondary education
2
2
Languages
Work History
OPERATIONS SPECIALIST
Sendero Health Plans
Austin, TX
06.2021 - Current
- Manage the Operations (received via email) Mailbox & ensure a timely resolution while maintaining a high-level of professionalism
- Receive and track incoming report deliverables, not limited to saving, logging, and distributing them to appropriate staff on a timely basis
- Following up with vendors to ensure we receive reports in order to meet deadlines and to maintain compliance
- Composing the Quarterly Newsletter on the Sendero Health Care website for members
- Manage the Complaints, Grievances & Appeals (email) mailbox and ensure they are delegated, initiated, worked, and logged to ensure timely processing per TDI guidelines
- Manage the Member Advisory Sub-Committee; reaching out to members via telephone and/or email, coordinate with departmental executives to determine what info they would like to contribute during meetings; scheduling times that work for all members, notating and addressing/ following-up with any items that need to be addressed. Serving as the Point-of-Contact for all committee members.
- Creation of departmental SOP’s & P&P’s
- Currently a member of the organization’s Diversity & Inclusion Committee, where I help coordinate community events with our sister companies (Central Health & Community Care)
SENIOR ACCOUNTING, ASSISTANT • SENDERO
Sendero Health Plans
Austin, TX
04.2015 - 06.2021
- Maintain revenue, medical expense and administrative expense entries within the general ledger
- Help manage accounts receivables and accounts payables
- Help make deposits, reconcile banking statements and monitor cash flow
- Assist in producing accurate and timely financial reports on a monthly, quarterly and annual basis to the Board of Directors, Health and Human Services, Texas Department of Insurance, and other external entities
- Manage intercompany transactions
- Prepare monthly journal entries related to revenue, cash, and accounts receivable
- Train and occasionally review the work of other supporting members of the accounting team
PATIENT SUPPORT REP
THE OUTSOURCE GROUP
Austin, TX
03.2014 - 04.2015
- Maintain assigned caseload including seeing in house patients and working call- backs timely and appropriately setting the standard in quality of work for your peers and subordinates
- Support Director of Operations in all Quality Assurance/Reporting Activities which may include Weekly/Daily Approval & Denial Reports, Weekly Billing Reports and Account Progress/Denial
- Ensure adherence to all RCA policies and procedures by all onsite Patient Support and coordinate with Director of Operations to address variances in process or procedures
- Hire/Train/Guide Patient Support Staff in daily process and provide feedback and guidance on questions/cases with which they may not be familiar
- Assist Director of Operations in monthly account audits with notes documented in Secure on all accounts over $25k for assigned facilities as requested
- Ensure facilities are staffed according to contract requirements -Communicate any need for corrective action to the Director of Operations
- Assist with training for new staff as well as ongoing/updated training for current staff
- Ensure that all compliance rules and policies are followed including RCA, Hospital, and HIPAA guidelines
- Maintain positive relationships with hospital peers and Directors/Managers
- Maintain an awareness of quality of service and product and make timely recommendations to Director of Operations of needed revisions to Standard Operating Processes, Reporting, or other items
PROGRAM SPECIALIST
Sendero Health Plans
Austin, TX
06.2013 - 03.2014
- Provide computer entries of authorization request/provider inquiries by phone, Mail, or fax
- Verify member eligibility and benefits
- Determine diagnosis and treatment request
- Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes)
- Verify inpatient hospital census-admits and discharges,
- Respond to requests for authorization of services submitted via phone, fax and mail according to operational timeframes
- Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director
- Notify nurses and case managers of hospital admissions and changes in member status
- May assist in the research and resolution of claims payment issues
- Manage, administer, and reconcile Sendero employee purchasing card program
- Train and occasionally review the work of other supporting members of the accounting team
DIRECTOR oF PATIENT SUPPORT
RESOURCE CORPORATION OF AMERICA
Austin, TX
07.2008 - 06.2013
- Maintain assigned caseload including seeing in house patients and working call- backs timely and appropriately setting the standard in quality of work for peers and subordinates.
- Established departmental performance goals and provided feedback for underperforming areas.
- Support Director of Operations in all Quality Assurance/Reporting Activities which may include Weekly/Daily Approval & Denial Reports & Weekly Billing Reports.
- Ensure adherence to all RCA policies and procedures by all onsite Patient Support and coordinate with Director of Operations to address variances in process or procedures
- Hire/Train/Guide Patient Support Staff in daily process and provide feedback and guidance on questions/cases with which they may not be familiar.
- Assist Director of Operations in monthly account audits with notes documented in system on all accounts over $25k for assigned facilities as requested
- Ensure facilities are staffed according to contract requirements -Communicate any need for corrective action to the Director of Operations - set up and interviewed potential candidates.
- Assist with training for new staff as well as ongoing/updated training for current staff.
- Ensure that all compliance rules and policies are followed including RCA, Hospital, and HIPAA guidelines.
- Maintained and fostered positive relationships with hospital peers and Directors/Managers.
- Maintain an awareness of quality of service and product and make timely recommendations to Director of Operations of needed revisions to Standard Operating Processes, Reporting, or other items as needed.
Education
Associate of Science - BEHAVIORAL SCIENCE
CONCORDIA UNIVERSITY
Austin, TX 05.2005 - 08.2007
BBA - MULTI-DISCIPLINARY STUDES, BUSINESS & PSYCHOLOGY
CONCORDIA UNIVERSITY
Austin, TX 06.2021 - 10.2022
Skills
Management experience with proven leadership abilities
undefinedAccomplishments
1. Supervised, trained, and led a team of 6+ staff members.
2. Commended by upper-management (Director of Operations) for the quality and consistency of my performance.
3. Created and presented an excellent image of the company and its services to the HCA facility.
4. Was promoted within one year in the role.
5. Hired, Interviewed, Managed & Trained all new employees.
6. Fostered a collaborative work environment through various team-bonding initiatives.
7. Assisted with developing an employer manual, including training guidelines and disciplinary procedures.
Timeline
BBA - MULTI-DISCIPLINARY STUDES, BUSINESS & PSYCHOLOGY
CONCORDIA UNIVERSITY
06.2021 - 10.2022
OPERATIONS SPECIALIST
Sendero Health Plans
06.2021 - Current
SENIOR ACCOUNTING, ASSISTANT • SENDERO
Sendero Health Plans
04.2015 - 06.2021
PATIENT SUPPORT REP
THE OUTSOURCE GROUP
03.2014 - 04.2015
PROGRAM SPECIALIST
Sendero Health Plans
06.2013 - 03.2014
DIRECTOR oF PATIENT SUPPORT
RESOURCE CORPORATION OF AMERICA
07.2008 - 06.2013
Associate of Science - BEHAVIORAL SCIENCE
CONCORDIA UNIVERSITY
05.2005 - 08.2007
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