Claire Babcock
756 Blackswoods Road
Cherryfield, ME  04622
[Send email using form at bottom]
(207)546-4281 Home

Employment

05/09 – current Eastern Maine Medical Center
Risk Management Coordinator
•	Investigate Incident Reports, phone calls and medical device problems for
possible Sentinel Event reporting to the state of Maine.
•	Coordinate the Significant Event Assessment Team (SEAT) meetings with research
material for high level reviews for process improvement, policy changes and
education.
•	Facilitate Intensive Reviews and/or Root Cause Analysis to ensure resolution
for any future patient harm.
•	Plan and participate in presenting Continuing Education Units (CEUs) classes
for nurses on “Lessons Learned” from Sentinel Events that have happened.
05/08 – 5/09 Risk Management Associate
•	Maintain Incident Reporting database, Peminic, with ongoing clean up of data
and testing.
•	Establish searches per management requests and provide end user training of
the software.

06/07 – 02/08 Maine Coast Memorial Hospital
Quality Improvement Liaison and Auditor
•	Coordinated employer sponsored registry for employees/patients with chronic
disease illnesses to measure provider performance based on national guidelines
for managing chronic diseases.
•	Managed and monitored hospital quality incentive program to ensure Blue Cross
Blue Shield claims achieved 80% or greater positive outcome on data for pediatric
and adolescent well-visits and immunizations, adult CVD’s and adult diabetes
based on national association guideline.
•	Provided technical support for Physician Quality Incentive Program to ensure
diabetic patient visits were billed on a super bill with CPTII codes for
Medicare’s outpatient compliance program for chronic illnesses.
•	Trained staff on how to run quality improvement based reports to measure
compliance with national chronic disease guidelines.

9/00 – 06/07 University of Massachusetts Medical School
Disability Reviewer/Appeals Reviewer
•	Conducted continuing disability reviews and compared medical information to
determine if clients could maintain ongoing eligibility for SSI benefits and
insurance.
•	Reviewed applications for SSI disability insurance under the Basic to Standard
Program using SSI criteria and guidelines.
•	Completed a thorough review of a client’s medical record using the Disability
Evaluation Services guidelines to ensure an accurate assessment of the client’s
medical condition was presented at a denial hearing.
•	Defended denial made by the DES for MassHealth, EAEDC and TAFDC programs at
appeal hearing attended by a hearing officer, the client and a legal
representative.
Division of Medical Assistance Program Coordinator – Third Party Liability Unit
•	Coordinated insurance benefits with third party payers on behalf of MassHealth
members.
•	Developed and implemented policies and procedures for internal and external
referrals.
•	Formulated cost savings and cost avoidance for the Division of Medical
Assistance.
•	Identified appeals for recover of claims paid by the Division of Medical
Assistance.

5/98 – 09/00 Cardinal Health Care System
Clinical Data Specialist/Trainer
•	Trained hospital staff how to abstract medical records in a two day training
class.
•	Acted as a resource for experienced and new abstractors with answers to
Glossary questions and data collection guidelines.
•	Assisted clients with setting up reports for a statistical analysis on in
patient stay based on JCAHO measures chosen for short and long term improvement.

12/95 – 05/98 Genzyme Tissue Repair
Reimbursement Coordinator
•	Developed specific payer and territory strategies to support sales, marketing
and reimbursement process.  Achieved a 62% reimbursement rate in New England
territory.
•	Secured 3rd party coverage for autologous cell therapy for new medical
technology.
•	Managed reimbursement activity for Boston/New England Territory supported by a
business plan.
•	Taught reimbursement-training classes for hospitals and physician staff to
limit financial exposure.
•	Taught Continuing Education Unit (CEU) program for nurse case managers on cell
therapy and reimplantation.

12/86 – 12/95 Blue Cross Blue Shield of Massachusetts
Medical Policy Implementation Analyst/Provider Relations Program
Manager/Clinical Review Analyst
•	Implemented workflow for Physician’s services to be reviewed for coverage or
additional payment.
•	Acted as liaison between physician in Boson and BCBSMA as a first line of
response to provider issues with BCBS.
•	Trained medical staff on coding, terminology, medical policy and claims
processing.
•	Participated on taskforce to educate problem physician groups, which reduced
waiting time for claim adjudication and improved customer satisfaction.
•	Determined pricing of complex surgical claims, team surgery, and clinical
service’s which required manual intervention.
•	Implemented Medicare contract with biweekly training to outreach offices.
•	Reviewed operative reports on previously paid surgical claims for additional
allowance incorporating policies and guidelines.

12/85 – 12/86 Harvard Pilgrim Healthcare
Provider Relations Representative
•	Responsible for the education and training of new physician’s and their office
staff to the HMO.

12/84 – 12/86 Wear Guard Work Clothes
Telephone Marketing Representative
•	Sold surgical scrub contracts in hospitals throughout the U.S.

09/75 – 12/84 Waltham Weston Hospital
Emergency Room Nurse
•	Responsible for assessment and treatment of multiple trauma victims, cardiac
arrest, elderly illnesses, acute and chronic diseases and pediatric conditions.

Computer Skills
Outlook, Microsoft Work, Excel, Power Point

Education
BS Business Administration, University of Massachusetts
Diploma in Nursing, LPN Quincy Hospital, Massachusetts