Gemma Tosto
- Role
- Executive Director, Nca Integration and Support Services at Kaiser Permanente
- Location
- San Francisco, CA, US
- LinkedIn followers
- 500 followers
About Gemma Tosto
Leader in an Integrated Delivery Model having served in both Hospital and Medical Group…
Experience
Executive Director, Nca Integration and Support Services
May 2017 — Present
Operations leader for Claims Intake, Admin Output, Provider Portal, Business Integration Technology Services, PMO and SMILE.\\\\n \\\\nThis position is directly responsible for Claims Support. This includes leading:\\\\nFront end claims intake - Paper Intake including managing mail for claims, RFIs, member reimbursements, foreign claims, Medicare Part D member reimbursements, provider appeals.\\\\nEDI teams supports all trading partners, clearinghouse enrollments for providers electronic claims submissions, electronic fund transfers (EFT) and electronic remittance advice (ERA)\\\\nBack end claims operations team – Administrative Outputs - EOBs, EOPs and letter generation\\\\nInternal training and documentation of desktop level procedures to support claims operations and supporting functions\\\\nProvider Portal team to enable our providers to exchange information related to administrative and clinical information (eligibility, benefits, claims status on line)\\\\nProduction Support team which has accountability for the multi-year plan (MYP) to optimize our claims platform.\\\\n\\\\nTeams/Functions reporting to this role include:\\\\nBusiness Integration and Technology Services\\\\nClaims Intake and EDI Reconciliation\\\\nNational Learning and Performance Management\\\\nProject Management Office (PMO)\\\\nClaims Correspondence\\\\nProvider On Line Portal\\\\n \\\\n\\\\n \\\\n \\\\n\\\\n \\\\n
Skills
- Informatics
- User Acceptance Testing
- Cross-Functional Team Leadership
- Integration
- Parallel Validation Testing
- Vendor Management
- Process Improvement
- Team Building
- U.s. Health Insurance Portability and Accountability Act (Hipaa)
- Health Insurance
- Hipaa
- Healthcare Information Technology (Hit)
- Management
- Medicare
- Health Policy
- Software Development Life Cycle (Sdlc)
- Strategy
- Healthcare Information Technology
- Business Process Improvement
- Ehr
- Electronic Medical Record (Emr)
- Revenue Cycle
- Epic Systems
- Healthcare Consulting
- Program Management
- Strategic Planning
- Leadership
- Emr
- Hospitals
- Business Analysis
- Sdlc
- Project Management
- Healthcare Management
- Change Management
- Healthcare
- Managed Care
- Healthcare Industry
- Medicaid
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