Cynthia Reed-Robinson
(510) 297-5624
cdrthediva@sbcglobal.net
Objective: To obtain a position which will allow me to utilize my experience and education, and also provide an opportunity for professional challenge and personal growth.
Qualifications
Exceptional management and administrative skill including strategic planning, goal setting, personnel training, and cost reduction.
Strong presentation, negotiation, account/project/product management abilities.
Excellent research, analytical, written and oral communication skills.
Extensive computer experience in healthcare and database applications.
Ability to work under pressure and rapidly changing priorities as part of a team, or independently.
Experience
09/95 Present Corporate Diva Inc., Tracy, CA - Chief Executive Officer
Serve as an independent contractor/consultant for various healthcare providers/entities throughout the country in the following capacities: project manager, business/operations manager, establishing, moving, and redesigning physician practices, system implementation, creation of multi-specialty clinics, system design, integration, and implementation work, process and work flow analysis, medical/dental biller, implementation of policies and procedures, assist in merger acquisition, contract negotiations, vendor/account management, claims management, HIPAA compliance, reimbursement strategies, budgeting and forecasting, goal setting, and sales/marketing.
12/03 12/05 Sikka Software Corporation, San Jose, CA Director, Sales and Operations
As the Director of Sales and Operations I had overall responsibility for the sales, accounting, technical support and administrative staff. Lead the sales team in generating revenue to meet and/or exceed the budget goals. In collaboration with the CEO prepare marketing, advertising, sales plans, programs, and the annual budget. Cultivate existing client relationships, partnerships, and alliances; serve as the main liaison and fielding incoming inquiries, RGQS and issues surrounding contracts and orders. Build new relationships with prospective clients in target markets with routine follow-up via e-mail and telephone. Prepare and deliver onsite and offsite presentations to interested parties. Represent the company at various tradeshows, conferences and seminars. Craft and execute personalized sales and marketing strategies while supporting existing marketing plans.
8/03 9/05 Delano Surgical Group, Delano, CA Practice Administrator (Consultant)
My objective was to restructure the entire practice to ensure efficiency and profitability in all areas of the surgical group. This entailed recruiting and terminating of staff, training and mentoring staff, implementing new policies and procedures for billing, payroll, budgeting, patient retention, scheduling, and client hours. Negotiated and renegotiated managed care and vendor contracts with applicable health plans to ensure maximum reimbursement. Created a bariatric clinic/program that included patient education, creation of training material, and written documentation for potential clients. Created a policy and procedure manual for overall practice work flow as well as an employee handbook for the entire practice. Also was responsible for inventory control, budget forecasting, marketing, and performance evaluations.
9/02 1/05 Medrium, Inc., San Francisco, CA Manager, Practice Management Services and Sales
In the role of Manger of Practice Management Services I was responsible for training, mentoring, budgeting, goal setting, and performance reviews for the following departments: Technical Support, EDI Enrollment, Sales, and Training. Lead the sales team in conducting product demonstrations of the web based application to potential clients and the implementation of the product for new clients. Handle all aspects of support for new and existing clients, including timely resolution of all issues related to the usage of the ASP Practice Management System. Implemented a detailed training program and produced training manuals for providers and various internal departments. Account management to clients on the billing service part of the business for clients in the Southern states and on the East Coast. Lead various large projects from implementation through the entire life cycle of the project.
1/01 9/02 San Francisco Health Plan, San Francisco, CA Director, Providers Relations
As the Director of Provider Relations I was responsible for the recruiting process of IPAs, hospitals, clinics, and ancillary providers to become contracted providers with the health plan. Responsible for the oversight of all state and federal regulatory compliance in regards for the contracted Medical Groups. Lead contract negotiations with potential health care entities. Lead the project management team in implementing a claims processing system from the selection of the system to implementation of the system with each department within the health plan. Created a work flow for the claims department that entailed claims distribution, processing, and internal review. Also responsible for the training, budgeting, goal setting, and performance reviews for the following departments: Provider Relations, Credentialing and Claims.
7/99 3/01 PacifiCare of California, Concord, CA Contracts Manager Recruited targeted physician groups, ancillary providers and hospitals to PacifiCares networks. Developed negotiating strategies and conducted negotiations with specified providers. Developed models for negotiations and what-if scenarios by using contract support system. Responded to complex provider inquiries regarding PacifiCare, contract issues and administration, and reimbursement to facilitate recruitment activities. Completed competitive assessment of markets and assist in development of network recruiting goals. Developed recommendations on pricing, access, and other network features. Coordinated the approval process of non-standard reimbursement arrangements. Assisted with the process for contract execution implementation. Ensured that all provider contracts are produced in accordance with PacifiCare and Shareholder standards. Developed positive relationships with providers, hospitals, and insurance carrier representatives. Responded rapidly and appropriately to issues that arise. Assisted carriers in pre-sale and post-sale education of employer groups, brokers or consultants. Proposed appropriate revisions to current projects or future business plans.
11/97 9/00 Redwood Health Services, Santa Rosa, CA Account/Contracts Manager (Consultant)
Managed all aspects of the business relationship with assigned clients to ensure appropriate services were available and utilized to provide the highest possible caliber of service. Served as the liaison with the health plans, contracted physicians/entities, billing services providers, and other contracted clients. Responsible for overseeing reimbursement analysis, payer relations, preparation and analysis of monthly accounts receivable financial reports and ensuring overall service quality and client satisfaction. Managed day-to-day operations of the business in compliance with established procedures. Managed workload flow of claims, benefit administration and accounts receivable functions for client. Enforced compliance with local, company and billing policies, procedures, safety rules, and governmental regulations. Responsible for the overall direction, coordination, and evaluation of managers, supervisors, team leaders, data entry, clerical, payment posting, claims, accounts receivable (a/r), and patient service representatives units.
2/93 1/98 LeRoy Accountancy Corp., San Francisco, CA - Health Claim Auditor (Consultant)
Conducted complex medical claim adjudication projects. Reviewed claims for accuracy and conformance to standards. Inspected financial and/or operational information to ensure procedures are correct and appropriate. Compiled audit findings and recommended revisions to claims software, work flow, and procedures. Provided claims administration solutions to the healthcare industry. Assisted clients in backlog situations and effective ways to resolve production issues. Implemented polices and procedures that included audit tools to ensure a positive resolution. Additionally provided internal pre/post payment provider bill audit on workers' compensation bills to identify aberrant patterns of practice, over-utilization, fraud, and/or abuse. Requested and reviewed medical records for appropriate charges and conducted provider /claim service verification. Served as a medical resource for claims, IT, and benefit administration staff and provided assistance on specific claims. Provided education to providers on correct billing practices as well as a review of specific audit issues
11/93 9/99 Kaiser Permanente Medical Group, Oakland, CA - Outside Referral Coordinator (Consultant)
Responsible for the identification and preliminary analysis of opportunities to establish contractual relationships with suppliers of goods, equipment and services, pursuing opportunities through the use of negotiations, Request for Proposal (RFP)and competitive bidding processes, contractual development, negotiations, and facilitation of the approval processes associated with the successful implementation of the opportunities pursued. The position was tasked with the maintenance of the comprehensive contracts management program by establishing a portfolio of master contracts ensuring competitive pricing of the goods, equipment and services for Kaiser Permanente members to utilize.
7/87 11/93 Lincoln National Life, Pleasanton, CA Claims Manager
Responsible for the operations of a regional, high-volume claims recovery unit dedicated to all lines of business and products offered through Commercial and Medicare Lines of Business. Operational functions included management of the review, identification, validation and recovery of overpayments. Reviewed overpayments which included duplicate payments, Contract Compliance, Authorizations, Eligibility, Coordination of Benefits and Medical Review. Managed team members to ensure unit goals were met in an efficient and effective manner. Maintained and established unit production standards per production employee. Maintained and established unit quality standards per production employee. Maintained and established unit turn around time standards. Provided information regarding departmental staffing and budgeting requirements. Managed and reconciled Provider Receivables accounts. Balanced claims inventory and strategically planning to maintain steady workflows. Assisted the Claims Director with annual budget provided information regarding departmental staffing and budgeting requirements. Coordination of Benefits and Third Party Liability savings targets Recovery savings targets. Analyzed, monitored, reported and made recommendations on various operational trends including discovery, hints and root causes. Responsible for recruiting, hiring, retaining, and training large, multi-leveled exempt and non-exempt staff. Development of staff and quality processes. Independently analyzed developing trends and implemented cost saving efficiencies and workflow processes. Developed, implemented, and monitored policies and procedures. Worked cross-functionally with Customer Services, Provider Services, Medical Management, Provider Contracting, Sales, Fee Negotiation, Underwriting, Membership and IS departments to insure timely and efficient workflows were developed and implemented. Worked closely with Customer Services, Provider Services, Medical Management, Provider Contracting and Sales to resolve and communicate member and provider issues. Managed the department in the adherence, audit responsiveness, and documentation preparation to several regulatory agencies including DMC, DOI, DHS and HCFA.
Technical Skills: Diamond, Medrium, Medical Manager, IDX, AS400, OPS, Ez-Cap, EPIC, JustInTime Scheduler, SQL, SAS, Salesforce, Unix, HTTP and HTTPS, HIPAA transaction sets, Crystal Reports, MS-Project, ASP, Microsoft Office Suite, EDS products, Medi-Soft, Perot Systems, Java Script, Oracle, SAP, HTML, Lotus Notes, Quickbooks, Dentrix, SoftDent, EzDental, EagleSoft, PeopleSoft, MicroSoft Project, Cerner, and various other healthcare applications and databases.
Education Control Data Institute, San Francisco, CA
San Jose State University, San Jose, CA
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