Sascha Roman
Austin,TX
Summary
Objective- Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Overview
17
17
years of professional experience
Work History
Operations Specialist
SENDERO HEALTH PLANS
06.2021 - Current
- Participated in meetings and associated events to help define and achieve organizational objectives.
- Monitored and tracked project execution of tasks.
- Collected, organized and provided data to maintain program status and customer commitments.
- Optimized customer experience by delivering superior services and effectively troubleshooting issues.
- Evaluated customer needs and feedback to drive product and service improvements.
- Cultivated positive relationships with vendors to deliver timely and cost-effective supply of services and materials.
- •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 for any incoming Complaints, Grievances, or Appeals and ensure they are delegated and logged, and worked 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 leads to determine what info they would like to contribute during meetings; scheduling times that work for all members, taking notes and addressing/following-up with any items that need to be addressed. Being the Point-of-Contact for all committee members.
•Analyze insurance policies of complainants by evaluating and interpreting the contract to determine the extent of coverage, the exclusions specified, and the conditions affecting the payment of claims; analyze the facts of the case by reviewing and evaluating the incidents pertinent to the claims to determine whether the policy coverage extends to such incidents.
•Creation of departmental SOP’s & P&P’s as needed.
•Assist with projects such as SBC’s, SOC’s, Benefits Grid, Provider info, and QA for accuracy.
•Review Softheon Web Queues and resolve issues/provide responses relating to them
•Attend various meetings with vendors and co-workers on an as-needed basis
•Communicate to vendors to ensure timely delivery of deliverables needed for members; maintain and cultivate relationships with vendors in order to ensure vendor contracts are adhered to.
Sr. Accounting Assistant
SENDERO HEALTH PLANS
04.2015 - 06.2021
- Maintain revenue, medical expense and administrative expense entries within the general ledger
• Help manage accounts receivable and accounts payable
• 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 - Processed payments and documents such as invoices, journal vouchers, employee reimbursements, and statements
- Recorded deposits, reconciled monthly bank accounts and tracked expenses
- Managed and responded to correspondence and inquiries from customers and vendors
- Generated invoices upon receipt of billing information and tracked collection progress
- Reconciled company bank, credit card and line of credit accounts, investigating and resolving discrepancies to keep accounts audit-ready
- Maintained account accuracy by reviewing and reconciling checks monthly
- Reconciled account information and reported figures in general ledger by comparing to bank account statement each month
- Created detailed expense reports to facilitate reimbursement for business expenses incurred
Program Specialist
SENDERO HEALTH PLANS
06.2013 - 07.2014
- 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
Supervisor of Patient Support
RESOURCE CORPORATION OF AMERICA
07.2008 - 02.2013
- 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 Reviews -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
- Ensure that all referred accounts are screened and processed timely, appropriately and efficiently
- 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
- Provide coverage for absent staff or staff on extended leave
- Be prepared to assist with extra duties of staff who may be absent or behind on assigned duties
- Ensure that all compliance rules and policies are followed including RCA, Hospital, and HIPAA guidelines
- Strong knowledge base of SSA/SSI disability as well as state Medicaid and local government programs
- Ability to establish a partnership approach with customers/clients/co-workers to accomplish goals and establishing a team management work structure to accomplish performance goals
- Maintain positive relationships with hospital peers and Directors/Managers
- Attend all meetings as scheduled or requested by Director of Operations
- Participate in special cleanup projects as requested by facility in coordination with Director of Operations
- Participate in assigned leadership projects as assigned
- Participate in quarterly Lead/Director of Operations Meetings
- Identify and communicate to Director of Operations specific training needs for your facility and team/review staff on quarterly basis to monitor competency
- 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
Administrative Assistant II/ Benefits Counselor
TEACHER RETIREMENT SYSTEM OF TEXAS
03.2006 - 07.2008
- Providing administrative support to the TRS ActiveCare Director and/or Team Leader when necessary
- Work independently auditing database reports on as needed basis
- In charge of Timekeeping/Payroll database as well as working closely with Payroll department to maintain timekeeping accuracy
- Providing a high level of customer service to TRS members as well as school district Officials regarding TRS ActiveCare benefits via telephone in accordance with TRS and Blue Cross Blue Shield of Texas provisions
- Responding to and resolving moderately complex telephone inquiries as well as incoming exception requests
- Communicating directly with Blue Cross of Texas customer service reps, school district officials, and school district employees, while conducting and analyzing research in order to either approve or deny incoming exception requests
- Sort, File, Distribute incoming and outgoing mail on daily basis
- Answering incoming phones to ActiveCare department as necessary
- Order departmental supplies as necessary
- Handling budgetary requests by Director for the ActiveCare Department and working closely with Accounts Payable Department in the process
- Maintain School District Filing system
- Executed record filing system to improve document organization and management
Education
BBA - Multi-/Interdisciplinary Studies
Concordia University At Austin
Austin, TXAssociate of Arts - Behavioral Sciences
Concordia University At Austin
Austin, TXHigh School Diploma -
William B. Travis High School
Skills
- Accounts receivable
- MS Outlook, Excel, PowerPoint
- Customer service
- Expense reports, Payroll
- Internal Controls
- Closing Procedures
- Vendor/Account Management
- Check Disbursement
- Monthly Reconciliations
- Accounts Payable and Accounts Receivable
- Staff Management
Timeline
Operations Specialist
SENDERO HEALTH PLANS
06.2021 - Current
Sr. Accounting Assistant
SENDERO HEALTH PLANS
04.2015 - 06.2021
Program Specialist
SENDERO HEALTH PLANS
06.2013 - 07.2014
Supervisor of Patient Support
RESOURCE CORPORATION OF AMERICA
07.2008 - 02.2013
Administrative Assistant II/ Benefits Counselor
TEACHER RETIREMENT SYSTEM OF TEXAS
03.2006 - 07.2008
BBA - Multi-/Interdisciplinary Studies
Concordia University At Austin
Associate of Arts - Behavioral Sciences
Concordia University At Austin
High School Diploma -
William B. Travis High School
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