Carmen Switzer

Experience

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  Kennewick General Hospital

  Mar 1998 - Dec 2012

  Clinic Administrator and Business Office Director

  Clinic Administrator: Accountable for the performance of Family Practice and Specialist Clinics. Maintained relations, communications, management of all administrative and provider staff. Ensured scheduling of staff to promote provider productivity as well as to promote high clinical quality, high service quality, operational and financial viability, and to ensure appropriate patient access to practice. Established and implemented goals, objectives, policies, procedures, and operational systems for the clinic. Monitored and controlled clinic expenditures within approved budget. Generated quarterly budget analysis. Identified problems that interfered with practice operations and developed action plan for resolution. Maintained and communicatedclinic standards to meet regulatory requirements to comply with safety and infection control. Actively assisted with provider recruitment efforts and assisted physicians with the development activities to build a successful practice. Ensured accuracy of payroll submission. Business Office Director: Responsible for revenue cycle management of a multi-specialty large provider network. Provided management, guidance and training to staff. Responsible for being up-to-date and knowledgeable with regard to diagnostic and procedure coding, and how it affects reimbursement. Ensured total accounts receivable at less than 60 days of average monthly charges. Established and maintained best practices relevant to business operations and payers; including managed care plans, as well as self-pay patients. Complied with contractual terms agreed to through payer contracts. Developed quarterly budget analysis. Developed a comphrensive coding and billing compliance program. Ensured accuracy of payroll submission. Show less

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  CHPW

  Jan 2011 - Aug 2023

  Provider Relations Administrator

  Develop, manage, and maintain relationship with managed care service providers. Keep open and regular communication with providers on user requirements and policies. Review billing and claim payment according to managed care contracts. Work with internal departments to resolve provider issues relevant to provider records and system configuration. Serve as a lead on various projects and committees with primary focus on operational improvements and best practices. Create and develop effective provider education materials and leading the effort to educate network providers. I use my extensive experience and judgment to plan and accomplish goals. Lead and direct the work of Provider Relations staff with a wide degree of creativity and latitude. Manage and negotiate provider contracts. Show less

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  Community Health Plan of Washington

  Jul 2023 - now

  Supervisor, Provider Relations