Denise Garland 510-***-****

***** ******* *****, *** *******, Ca 94580 abjc09@r.postjobfree.com

Professional Profile

Highly motivated and skilled professional, seeks a position within dynamic, high growth organization that welcomes

excellence in meeting business objectives. Exceptional ability to work under high pressure, complimented by a proven

Call Center Experience Team Leadership & Training

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Customer Service Medicare Appeals

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Case Management Product Knowledge

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Profit Management Client Relationship Management

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Conflict and Dispute Resolution

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Experience Highlights

Billing Specialist

Identified and resolved patient billing complaints

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Prepare and submit clean claims to various insurance companies electronically or paper.

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Process payments from insurance companies

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Prepare and review statements

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Medicare Billing Experience

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Medicare Secondary Payer Experience

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Knowledge of Medical Terminology

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Provider Relations

Assist in preparation of contracts when requested

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Ensure that PCP has current membership rosters

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Worked closely with other departments in the updating of the Provider Directory

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Assisting in utilizing service guideline, maintain network stability as it relates to physician/provider termina

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Maintained monthly service file to document monthly service educational visits to providers.

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Call Center/Customer Service

Averaged 150 to 200 calls per shift

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Maintained patient/provider confidentially according to HIPAA and company standards

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Accessed, input and retrieve information in the computer application

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Complied with federal and state laws, rules and regulations

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Researched benefit information

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Denise Garland•510-***-****•abjc09@r.postjobfree.com

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Processed referrals

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Case Management

Responsible for triaging, reviewing, investigating and coordinating Medicare member's appeals and complain

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Investigate and resolve Part C and D member complaints

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Provide resolution of the compliant in compliance with CMS regulatory requirements.

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Reviews pre service authorizations, concurrent and post service (retroactive review) medical necessity; bene

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Medicare

Management and Supervision

Promoted rapidly from lead to supervisor with the nations largest non profit health plan

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Supervise hour to hour, day to day function of the department

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Supervise Local 29 hourly employees and non union employees

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Conduct regular meetings with staff

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Provided job enhancement and development training

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Submitted Payroll

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Worked with Local 29 Shop Stewards to resolve union issues

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Submitted workers comp, disability, LOA documentation

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Work History

Billing Specialist Aeroteck, Brisbane, Ca

Provider Relations Coordinator Blue Shield of CA, San Francisco, Ca

Provider Relations Call Center Aetna, Walnut Creek, Ca

Sr. Case Manager Kaiser Permanente, Oakland, Ca

Supervisor Medicare Finance Kaiser Permanente, Oakland, Ca June 2002 January 2005

Education

CTU Online

Associate of Science Criminal Justice

References

References are available upon request.

Denise Garland•510-***-****•abjc09@r.postjobfree.com

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