Fikky Rendyka
Health Care Administrator
Pangkalpinang,Indonesia
Summary
Dedicated Healthcare professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Experienced Health Facility Management with over 10 years of experience in Healthcare and Health insurance. Excellent reputation for resolving problems and improving customer satisfaction. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
10
10
years of professional experience
6
6
years of post-secondary education
Work History
Referral Health Facility Staff
BPJS Kesehatan
Pangkalpinang, Kepulauan Bangka Belitung
08.2020 - Current
- Conducted primary source verifications such as background checks and board certifications.
- Received and evaluated applications to look for missing and inaccurate information.
- Enrolled providers and Medicaid, Medicare and private insurance plans.
- Maintained up-to-date knowledge of product and service changes.
- Met customer call guidelines for service levels, handle time and productivity.
- Partnered with healthcare teams to address care plan management, development and implementation.
- Conducted physical assessments of relevant body areas and performed standardized tests to check responses.
- Analyzed care plans, Medicare and Medicaid guidelines.
- Coordinated and integrated health care resources for community-based programs.
- Created help desk tickets, troubleshot and resolved desktop issues.
- Developed and tested new product offerings prior to release to assist development team in bug identification.
- Delivered onsite technical support for Health Facility.
- Negotiated optimal contract terms and conditions to lessen business risk and maximize financial objectives.
- Created and prepared specific contracts to present to management.
- Conducted quality reviews and monitored contract performance.
- Created and finalized contracts
Primary Healthcare Management
BPJS Kesehatan
Pangkalpinang, Kepulauan Bangka Belitung
06.2017 - 08.2020
- Assessed, analyzed and improved patient satisfaction ratings in outpatient facility.
- Audited quality of service departments and reported findings to department heads for improvements.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines, benefits administration and general liability.
- Communicated with patients, ensuring that medical information was kept private.
- Successfully negotiated client contract renewals to create increased satisfactory index.
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Contributed to and enhanced audit processes to maximize quality management standards.
- Conducted primary source verifications such as background checks and board certifications.
- Received and evaluated applications to look for missing and inaccurate information.
- Negotiated optimal contract terms and conditions to lessen business risk and maximize financial objectives.
- Created and prepared specific contracts to present to management.
- Created and finalized contracts.
Benefits & Relation Primary Health Facility Staff
BPJS Kesehatan
Pangkalpinang, Kepulauan Bangka Belitung
01.2015 - 06.2017
- Directed and controlled 401K, medical, dental and vision benefit packages.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Developed and implemented performance improvement strategies and plans to promote continuous improvement.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in-person interactions.
- Conducted primary source verifications such as background checks and board certifications.
- Received and evaluated applications to look for missing and inaccurate information.
- Enrolled providers and Medicaid, Medicare and private insurance plans.
- Developed summaries to assess each client's participation level and determine targets for follow-up plans.
- Improved sales abilities and product knowledge on continuous basis to provide optimal service and achieve quotas.
- Visited Health Facility, Goverment and community organizations to demonstrate products or services and answer questions from potential customers.
- Negotiated optimal contract terms and conditions to lessen business risk and maximize financial objectives.
- Conducted quality reviews and monitored contract performance.
- Created and prepared specific contracts to present to management.
Utilization and Quality Primary Healthcare Staff
BPJS Kesehatan
Pangkalpinang, Kepulauan Bangka Belitung
01.2014 - 12.2014
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
- Supervised and maintained all utilization review documentation.
- Monitored performance and generated reports detailing quality of services and defect rates.
- Documented data warehouse architecture to guarantee capacity met current and forecasted needs.
- Collaborated with multi-functional roles to communicate and align development efforts.
- Conducted primary source verifications such as background checks and board certifications.
- Received and evaluated applications to look for missing and inaccurate information.
- Prepared records for site visits and file audits.
- Negotiated optimal contract terms and conditions to lessen business risk and maximize financial objectives.
- Created and prepared specific contracts to present to management.
- Reviewed current contracts to identify upcoming contract expirations and coordinated with stakeholders to analyze contract renewals and re-negotiation.
- Conducted quality reviews and monitored contract performance.
Provider Relations Specialist
PT. Askes (Tbk.)
Pangkalpinang, Kepulauan Bangka Belitung
01.2013 - 12.2013
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Updated, proofed and distributed provider directories, using Ms. Office and CorelDraw.
- Reviewed expenses and fund allocations for accounts at regular intervals to verify credited surplus and deficits based on payment schedules and claim submissions.
- Negotiated collective bargaining agreements.
- Enrolled providers and Medicaid, Medicare and private insurance plans.
- Partnered with healthcare teams to address care plan management, development and implementation.
- Recommended service improvements to minimize recurring patient issues and complaints.
Verification Representative
PT. Askes (Tbk.)
Pangkalpinang, Kepulauan Bangka Belitung
03.2012 - 12.2012
- Verified insurance benefits and obtained pre-authorizations before any medical procedures were performed.
- Contacted insurance companies to determine levels of coverage and benefits information for patients.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Verified client information by analyzing existing evidence on file.
Education
High School Diploma -
Vocational Nursing School
Sungailiat, Bangka 06.2005 - 05.2008
Associate of Science - Nursing Practice
Nursing Academy
Pangkalpinang 08.2008 - 10.2011
Skills
Healthcare facility management
undefinedIT Healthcare Experience
Electronic Medical Record, Online Bridging System and Mobile Health Information Services
Timeline
Referral Health Facility Staff
BPJS Kesehatan
08.2020 - Current
Primary Healthcare Management
BPJS Kesehatan
06.2017 - 08.2020
Benefits & Relation Primary Health Facility Staff
BPJS Kesehatan
01.2015 - 06.2017
Utilization and Quality Primary Healthcare Staff
BPJS Kesehatan
01.2014 - 12.2014
Provider Relations Specialist
PT. Askes (Tbk.)
01.2013 - 12.2013
Verification Representative
PT. Askes (Tbk.)
03.2012 - 12.2012
Associate of Science - Nursing Practice
Nursing Academy
08.2008 - 10.2011
High School Diploma -
Vocational Nursing School
06.2005 - 05.2008
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