Deborah Taylor Nolff

*** ****** ***** *****

Greenville, SC. 29605

Mobile: 864-***-****

Summary

I have a diverse skill set including office management and supervision,

oral and written communication skills, audit and financial management,

accounting, medical-dental and hospital CPT 4, HCPCS, UB92 and ICD-9 and

CDT coding, claims processing and benefit administration. I am a hard

working, loyal individual driven by meeting personal and professional

goals.

Professional Experience

GHS University Medical Group, Greenville, SC

9/21/09 to current

Account Specialist - Billing and Collections for multiple practices on

Commercial Health Insurance, Medicare and Medicaid, Workers Comp,

Occupational Medicine, inquiries and appeals as needed to ensure

anticipated claim reimbursement according to contracted rates.

3/1/93-08/04/2009

Kanawha HealthCare Solutions, Inc. (now known as KHS a Humana Company)-

Greenville, South Carolina office closed 8/4/09

Lancaster, SC office to close 11/30/2010.

Service Operations Manager for Greenville Office 1999-2009

Asst. Claims Mgr. 1998-1999

Claims Supervisor 1996-1998

Team leader 1995-1996

Claims Examiner 1993-1995

Position duties:

Managed the daily operations of a third party administrator's claim

operation, customer call center and support services (including eligibility

and COBRA administration.)

Monitor turn-around time, quality, inventory of claims and call center,

results and monitor overall client satisfaction results.

Analyze the various departments' data entry for accuracy and compliance and

complete system adjustments and corrections to data entry. Compilation of

data is used to provide weekly, monthly, quarterly and year end reporting.

Investigate, research and respond to letters of appeal, subpoenas, legal

and Department of Insurance inquires. Appeal non-reimbursed stop loss claim

filings with excess risk carriers. Work with attorneys and clients to

resolve subrogation liens while maintaining a professional representation

of the organization.

Coordinate with Medical Management regarding appropriateness of care based

on Plan language regarding questionable treatment plans. Negotiate vendor

discounts, and interact with multiple PPO network vendors regarding terms

of contracts.

Coordinate new case set-up for new business, testing of claims, group set

up and networks prior to start up of claim processing. Tested benefits

once loaded to assure that claims were paying in accordance with Plan

documents. Meet with new clients to demonstrate claim department technology

and address specific client needs and requirements.

Maintain current knowledge of varied plan designs, Coordination of

Benefits, Medicare, Medicaid, COBRA, CHIPRA, HIPAA and FMLA

administration.

Develop department budget and operate within that budget.

Fulfill the duties of Human Resources Manager for this remote office

assisting associates with eligibility and benefit questions, claim filings

for STD, LTD, FMLA and maintained the appropriate required documentation.

Conduct interviews and reference/background checks. Prepare annual

performance reviews and determined appropriate pay increases within the

budget, then discuss reviews with the associate. Administer disciplinary

actions (coaching, counseling and improvement plans with follow-up). Review

and track attendance and enter/approve bi-weekly payroll in ADP

system. Developed processes and procedures so that two remote offices could

operate consistently according to company mission statement.

Handle high level call backs and questions for claimants, providers,

groups, carriers and legal counsel, which required independent decision

making, creativity and discretion to provide problem resolution.

Review and release claim benefits for high dollar claims up to 1 million

dollars review and coordinate claim filings to Excess Risk Carrier for

reimbursement.

Education

Graduate of TL Hanna High School, Anderson SC. Attended Anderson College,

Anderson, SC. with course study in secretarial sciences and business.

Received certificates from Kanawha Insurance in Microsoft Word, Excel,

Access and PowerPoint, Certificate of Completion in Market Conduct

Training, and Certificate of Completion for Management Training Course.

Completed an accredited course for Medical Inpatient and Outpatient

Physician Coding (AAPC) on November 6, 2010, CPC certification achieved.

Awards

Achievement of Excellence Awarded by client Harbert Yeargin Construction,

now known as Rust Constructors, a division of Raytheon Engineers and

Constructors for outstanding Claims and Customer Service at their company

awards banquet.

Accomplishments:

Successfully managed satellite benefits office in excess of 14 years by

meeting/exceeding production and performance standards established by

corporate office.

Received constant compliments from clients/vendors on entire staff for

professionalism, thoroughness and meeting and exceeding client's

expectations.

Implemented an Impact Plan for the different areas of management

responsibility (i.e. claims, call center and admin support) so that the

employees ultimately had input and control over the outcome of areas that

needed and/or required improvement. Documented the goals that were

established and assisted the area with development of tools to measure

progress toward attaining goals.

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