1. ANA RAMOS
69 Deering Road, Mattapan, MA 02126 617-435-3591 ana.ramos478@gmail.com
QUALIFICATIONS
 Leader and motivator
 Ability to work in a high pressure fast
paced environment
 Quick learner
 Strong interpersonal, organizational and
communication skills
 Extensive knowledge of all facets of
Managed Care Services, Microsoft
Software, Apple Software,3rd
Party
Billing, Claims,and Prior Authorization
Requirements
 Demonstrated ability to manage,
prioritize, organize and meet deadlines
 Effective problem solving, team building
and training skills
 Experienced with BICS, IDX, LMR
NOAH and Percipio hospital based
systems.
 Skilled with Blue links, Emdeon, Health
trio, MMIS, Nehen Express, AIM and
NIA payer tools
 EPIC Super User
EXPERIENCE
BRIGHAM AND WOMENS’ HOSPITAL- Southern Jamaica Plain Health Ctr. Jamaica Plain, MA
Finance Manager/Managed Care 09/12-Present
 Provide supervisory oversight, support and guidance to a team of four Financial Counselors.
 Works collaboratively with patients, providers, case manager and community outreach workers to
assist patients with financial assistance, by providing Mass Health, Health Safety Net,
financial/insurance information and application assistance.
 Responsible for processing prior authorizations for medications as well as radiology procedures and
exams.
 Supervise the daily Referral and Pre-Registration process
 Responsibilities include creating and implementing work flows and best practices for functions
including registration, managed care referrals, insurance verification, prior authorizations for both
radiology and specialist appointments
 Responsible for customer service to patients/providers/specialists/payers in a private manner.
 Monitors outstanding balances and maintains consistent follow-up to ensure patients resolve
outstanding balances
 Reporting Structure: 4 direct reports, 8 indirect reports; reported to the Nursing Director.
BRIGHAM AND WOMENS’ HOSPITAL- Southern Jamaica Plain Health Ctr. Jamaica Plain, MA
Case Manager 04/11- 09/12
 Identify those clients in need of case management; identify areas of medical and social concern.
 Interacting with families and individuals to assess their needs and find social programs to assist.
 Provide and identify case management need to high risk OB patients of the BWH Perinatal Case
Management program.
 Collaborate with clinical staff in the development and execution of the plan of care, and achievement
of goals.
 Establish and maintain professional relationships with local community resources (Healthy Baby
Healthy Child, Cradles to Crayons, Fragment Society, ETHOS, and neighboring health centers).
 Maintain database of patient case load.
 Provide patients with guidance, support, education and counseling to ensure coordination of care.

2. PARTNERS HEALTHCARE-Patient Service Center (PSC) Medford, MA
Managed Care Supervisor 02/08-04/11
 Provide supervisory oversight, support and guidance for a team of 24 Managed Care Representatives.
 Utilize strong interpersonal and communication skills to motivate and mentor staff with a focus on
increasing productivity.
 Provide senior management with various statistical, written and performance reports in a timely
manner.
 Provide staff with guidance and support in working with various insurance providers on matters related
to collection problems.
 Serve as liaison between senior management and Managed Care Representatives to
communicate new organizational policies or requirements.
 Reporting Structure: 12 direct reports, 24 indirect reports; reported to the Operations Manager.
PARTNERS HEALTHCARE-Patient Service Center (PSC) Medford, MA
Managed Care Representative 08/07 – 02/08
 Provided on-site referral management support to patients of Brigham and Women’s Southern Jamaica
Plain Health Center; coordinated approvals/denials by providers and processed all requests.
 Communicated referral management requirements to all patients and obtained all external approvals.
 Utilized on-line tools to process referral and authorizations; accurately updated the registration/billing
system with approval criteria.
 Provided confidential customer care to patients in both English and Spanish at the Partners
Healthcare Patient Service Center assisting with all referral, claims and billing related issues;
contacted payers when necessary to get an explanation of benefits and/or have claims adjudicated.
 Coordinated referral requests, approvals and denials between primary care providers and patients.
 Followed-up on all denied requests and advised patients how to proceed.
GUSO’S ITALIAN GRILL Clermont, FL
Restaurant Manager 12/06-07/07
 Manage restaurant operations, including coordination and synchronization of multiple work teams to
provide efficient service while maintaining high organizational standards for quality
 Conceptualize and implement innovative business and marketing plans to increase sales and
organization's profitability.
 Review and analysis of sales, provide senior management with detailed financial and budget reports.
 Provide senior management with recommendations on streamlining operations and lowering operating
costs with a view to maximizing profitability.
 Implement new staff development and training plans focused on recruitment and retention of
motivated staff.
 Develop employee training and recognition program.
 Develop organizational service standards to provide guests with high quality experience.
 Act as primary point of contact for guests - from reception to addressing their concerns with their
experience during a visit.

3. HANGAR PROSTHETICS AND ORTHOTICS Ocoee, FL
Operations Manager 10/05-12/06
 Supervise the daily Referral and Pre-Registration process of 30 + employees within 9 clinics.
 Assist with employee productivity reviews.
 Attend weekly, monthly Team Forums for up to date hospital and insurance information.
 Manage the daily workload of a Managed Care Coordinator and assist her with same day, next day
surgical procedures as well as self-pay patients for surgical procedures.
EDUCATION
College for America/ Southern New Hampshire University
A.G.S. Associates Degree in General Studies / in progress
Suffolk University
Community Health & Community Health Center Management Certificate Program
Certificate /2013
Comprehensive Outreach Education Certificate Program(COEC)
Certificate/ 2012
The Management Fundamentals Certificate Program/Professional Development Series Partners Health
Care & Brigham and Women’s Hospital
Management Training/ 2008-present
Waitt House/Madison Park High School Collaborative
Diploma/ 1993
References Available Upon Request