Medical Staff Coordinator - Boston Medical Center-Brighton
(2026-04)
The Medical Staff Coordinator acts as the primary link between senior management, the medical staff, and regulatory bodies.
- Managing the administrative, operational, and compliance functions of the medical staff, ensuring credentialing, privileging, and governance processes meet hospital policies, bylaws, and regulatory standards
- Review, analyze, and process credentialing and privileging applications.
- Verify education, training, and experience; identify 'red flag' items.
- Coordinate post-committee processes, database updates, and file completion.
- Oversee re-credentialing, appointments, reappointments, and performance evaluations
- Schedule, coordinate, and prepare agendas for medical staff committees; record and process minutes.
- Maintain rosters for committee memberships and medical staff.
- Provide administrative and clerical support to medical staff officers.
- Support continuing medical education initiatives in coordination with the medical education director.
- Ensure compliance with federal, state, and local regulations, hospital bylaws, and accreditation standards.
- Maintain accurate, confidential credential and peer review files.
- Prepare for accreditation surveys and audits.
- Advise practitioners and management on compliance issues.
- Serve as liaison between medical staff, nursing staff, administration, and external agencies.
- Maintain professional, confidential communication channels.
- Provide supportive services to ensure continuity of medical staff activities.
Credentialing/Provider Service Representative - MACIPA
(2022-04 - 2026-04)
- Manage MACIPA credentialing activities to ensure accuracy and compliance with standards and defined policies/regulations.
- Manage gathering of appropriate provider data and diligence documents and document all credentialing in appropriate records/files.
- Analyze provider credentialing applications for MACIPA in order to determine eligibility status.
- Maintain timely communication with providers regarding MACIPA credentialing decisions and/or related provider issues.
- Be a resource for internal departments for issues related to provider credentialing activities.
- Collaborate with department manager to discuss issues, obtain feedback, and disseminate information regarding credentialing issues.
- Assist to develop and implement MACIPA credentialing policies and procedures.
- Maintain provider information in credentialing application.
- Manage health plan enrollment process to ensure accuracy and completed in a timely manner.
- Oversee and manage the MACIPA credentialing application process and prepare/participate in Monthly Credentialing Committee Meetings.
- Establish and maintain a strong relationship with BLE/PHN and counterpart and prepare monthly information as requested.
- Continuously provide and monitor information on MACIPA Provider Directory for accuracy.
- Maintain confidentiality of credentialing information.
- Prepare and maintain provider lists as requested to providers and their staff, and MACIPA management.
- Coordinate and complete special projects as needed.
- Other duties as assigned.
- Interactive with Medical Staff Office @ Mount Auburn Hospital
- Facilitate provider onboarding efforts including but not limited to importing data from CVO into applicable systems, ensuring required documentation is complete and accurate, ensure all submitted documentation aligns with industry and organizational standards.
- Performs timely follow-up with providers on pending applications/information
- Perform primary source verifications according to the departmental policies and NCAQ standards when not completed by CVO.
- Builds and accurately maintains provider information in various systems
- Responds to inquiries regarding the status of provider's application
- Utilizes organizational templates to communicate with providers about the status of their application with the organization
E/O Weekend Patient Check-In Rep - Atrius Healthcare
(2023-11)
Professionally greets all patients entering the practice for medical appointments. Verifies patient demographics and insurance information, making any necessary changes in the Practice Management System. May obtain and enter appropriate referral information. Ensures all patients have completed and signed all forms as needed. Checks patients in, in order to inform clinical unit of patient's arrival. Collects payments for visit and outstanding balances, as necessary.
E/O Weekend Receptionist - Elizabeth Seton Residence/Marillac
(2022-10 - 2023-11)
- Working in healthcare setting/senior living facility-dementia certified
- Logging residents, vendors & visitors in/out of building
- Switchboard, taking messages, logging maintenance calls
- Assisting residents with daily tasks
- Deal with emergencies in a timely and effective manner, while streamlining office operations
Benefits Eligibility & Referral Social Worker A/B - Commonwealth of Massachusetts
(2013-04 - 2021-07)
- Determines initial and ongoing eligibility for transitional assistance programs and employment services.
- Conducts interviews, either in person, by phone or face-to-face, employing the Agency's PC based eligibility system known as BEACON.
- Ensures completion of initial/ongoing eligibility determination process and delivery of benefits services within timeliness standards.
- Obtains and verifies client information.
- Calculates accurate benefit levels.
- Performs all tasks related to case maintenance and case management, including referrals to other state agencies, health care providers and other sources as necessary.
- Prepares and delivers explanations of eligibility decisions.
- Issues appropriate benefit authorizations.
- Provides guidance, resources and referral assistance.
- Evaluates and monitors client cases to ensure compliance with applicable rules and regulations.
- Delivers those services required to assist individuals and families transition to work.
- Represents the Agency at appeal hearings.
- Responsible to perform related duties as required.
Patient Access Registration Representative (LAB/ED) (e/o weekend only) - Emerson Hospital
(2012-05 - 2013-05)
- Verifying the patient registration and insurance information prior to patient appointments
- Manage electronic work files to ensure that all such patient information is accurate and complete to allow for accurate technical and professional billing.
Patient Account Representative - Brigham & Women's Physicians Organization
(2012-01 - 2013-04)
- Sort and mail all bills (HCFA 1500) attaching any required documentation needed to receive payment (i.e. EOB for other secondary insurance, cost invoices, operative notes, etc.)
- Reconcile vendor accounts.
- Review rejection/denials from insurance carriers to determine what actions have been taken.
- Work test edits & scrubbers daily
- Account resolution may require calling insurance carriers, patients, lawyers, physician offices, medical records and other third parties.
- Work claim edits to fix claims that are not accepted by the payers electronically.
- Review aged trial balance and research outstanding patient accounts.
- Handle all additional follow-up required to get a claim processed and paid.
- Verify referrals & authorizations to in-patient & outpatient visits.
- Responsible for daily review and processing of insurance claims, verifying accuracy of encounters, entering charges, posting insurance and patient payments, maintaining assigned AR, and follow up on self-pay statements/budget plans.
- Payors include: BCBS, Medicaid, Medicare, Medex, HPHC, Network Health & other commercial plans.
Credentialing & Provider Data Coordinator - Beacon Health Strategies
(2010-11 - 2012-01)
- Credentials and recredentials behavioral health providers
- Received and performed intake process on new contracts including checking information for accuracy and completeness, record set-up in the system, data entry etc. and putting contracts and credentialing documentation in process.
- Researched claims submitted by unknown providers.
- Performed Primary Source Verification for individual credentialing & confirmation of facility accreditation and licensure.
- Received and processed provider information updates and follow up with departments for more information if needed.
- Processed executed contracts, mail out contracts and provider letters, file and scan executed contracts, update contract grids and initiate fee schedule loading, update W-9 forms.
- Processed enrollment information for PAR/NON-PAR for both new/existing providers
- Updated info in CAQH system
Patient Account Representative - New England Baptist Hospital
(2010-02 - 2010-11)
- Prepares and submits clean claims to various insurance companies either electronically or by paper.
- Claims follow-up, working on aging reports, answering billing questions, handling claims, monitoring payment/denial activity, ensuring adjustments are processed accurately.
- Completes billing on assigned carrier accounts.
- Resolves coding and charge errors with hospital departments.
- Prepares a weekly billing report of all accounts billed and unbilled.
- Responds to third party inquiries regarding billing errors, coding, and medical documentation.
- Pursues assigned billed accounts with third party payers.
- Conducts audits of account folders and corrects the errors.
- Posts payments that are received to proper patient account folders.
- Prepares refunds as needed.
- Evaluates patient's financial status and establishes budget payment plans, Follows and reports status of delinquent accounts.
- Acute hospital billing. Inpatient & Outpatient.
Billing Coordinator/Third Party Biller - New England Hematology/Oncology
(2009-06 - 2010-06)
- Sort and mail all bills (HCFA 1500) attaching any required documentation needed to receive payment (i.e. EOB for other secondary insurance, cost invoice, operative notes, etc.)
- Review rejection/denials from insurance carriers to determine what actions have been taken.
- Account resolution may require calling insurance carriers, patients, lawyers, physician offices, medical records and other third parties
- Work claim edits to fix claims that are not accepted by the payers electronically.
- Review aged trial balance and research outstanding patient accounts
- Handle all additional follow-up required to get a claim processed and paid
- Responsible for daily review and processing of insurance claims, verifying accuracy of encounters, entering charges , posting insurance and patient payments, maintaining assigned AR, and follow up on self pay statements/budget plans
- Payors include: Medicare/Medicaid, BCBS, HPHP, Tufts & all commercial plans.
Billing Issue Resolution Specialist - Multiplan
(2008-04 - 2009-05)
- Independently reviews and resolves practitioner and facility claims/complaints and client explanation of benefits to determine whether the allowed payment was appropriate
- Review provider history and/or claims information
- Complete practitioner and hospital claim resolution within department guidelines
- Communicate consistently and accurately with practitioners and hospitals until inquiry/case is resolved including conference calls when necessary
- Respond to client questions regarding appropriate interpretation and reimbursement of contracts
- Where necessary contact clients clearly and effectively to request adjusted claim payments
- Act as a liaison for appeal clients and internal claims staff by responding to questions regarding interpretation and reimbursement of practitioner claims
- Verify practitioner and hospital status, rates and claim information provided
- Identify trends, assist in training and work with department management to improve workflows and procedures
- Reprocess claims per contract on file for facility or hospital
- Reviews claim information and accurately enter HCFA/CMS and UB data from the claim form into the computer system by following specific guidelines and procedures
- Work closely with internal staff to identify root cause issues and own resolution
- Provide thorough and appropriate responses, initiate, coordinate and resolve issues to meet the goals of the department
Senior Claims Resolution Unit Analyst - Boston Medical Center Healthnet Plan
(2006-07 - 2008-03)
- Respond to all provider phone calls and correspondence including claims adjustment requests, appeals, corrected claims, timely filings and claims projects
- Resolve complex issues as referred by CRU Analysts
- Assist with the development of orientation and on-going training programs for CRU staff
- Maintain current knowledge of BMCHP benefits, provider network development and contract issues, Massachusetts Medicaid regulations, as well as industry standards for claims adjudication and other party liability issues
- Adhere to HIPAA guidelines
- Analyze reports to identify trends, routine errors, or other issues with provider contracts, system configuration or state regulations
- Report problems and trends to the Manager of CRU along with recommendations for process improvement
- Maintain department production and quality requirements
- Utilize all resources possible to obtain updated information, payor websites and NEHEN to verify eligibility and claim status whenever possible
- Coordinate special projects as assigned
Claims Resolution Unit Analyst - Boston Medical Center Healthnet Plan
(2006-07 - 2008-03)
- Respond to provider phone calls and correspondence including but not limited to, claim adjustment requests, appeals, corrected claims, timely filings, and claims projects
- Maintain current knowledge of BMCHP benefits, provider network development and contract issues, HIPAA regulations, Massachusetts Medicaid regulations, as well as industry standards for claims adjudication and other party liability issues
- Adhere to HIPAA guidelines
- Report problems and trends to Manager of Claims along with recommendations for process improvement
Provider Service Representative - Network Health
(2004-10 - 2006-06)
- Serve as the primary contact for providers and members with questions related to claims, benefits, member eligibility, timely filing, appeals and other topics related to Network Health
- Interface with claims, enrollment, IS, network management, pharmacy, behavioral health, and other internal teams to provide service excellence to our customers
- Assign primary care provides to members as necessary
- Meet all department standards regarding call center-related activity
- Always maintain confidentiality of information
- Consistently support Network Health's approach to service excellence by adhering to established department and company standards for all work-related functions
- Perform other duties as assigned by the director of customer service
- Assist marketing department with pilot program by making outbound calls to prospective members & educating new members about their health insurance benefits
Multiple Positions - John Hancock Signature Services
(2001-11 - 2004-04)
Held 3 positions w/company
- Business Analyst/Field Service Representative
- Disability Claims Representative
- Customer Service Representative
