Physician Insurance Analysts
Resume:
M
Raquel
Manalansan
adv9zl@r.postjobfree.com
Fairfax, VA 22030
SUMMARY
Seeking career advancement in the field of business administration where my personal experiences and educational training will be applied to the success and growth of the organization. Proactive leader with strengths in communication and collaboration. Adept at managing concurrent objectives to promote efficiency and influence positive outcomes. SKILLS
Microsoft Office
Adding Machine
EMR
EPIC
Cash Management Oracle
Availity Web Portal
Passport OneSource
McKesson One Content
Image Lockbox
Pulse Pro
TRAC Huron Healthcare Reporting
NThrive Application
KRONOS Application
IBM Kenexa Brassring on Cloud
Leadership Skills
Organization skills
Communication skills
Problem solving skills
Customer service skills
Data analysis
Decision making skills
Insurance terminology
Medicare/Medicaid knowledge
Database management
Insurance plan verification
Medical terminology
Skilled in Insurance Payer Websites
Electronic authorization processing
People skills
Team building skills
Working collaboratively
Analytical
EXPERIENCE
Physicians Insurance Analyst 3
Falls Church, VA
Inova Health System/ Jan 2019 to Current
Retained strong medical terminology understanding in effort to better comprehend procedures.
Updated all patient and insurance data regularly and carefully inputted changes into company's computer system.
Responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims, while meeting the expected productivity and quality standards on a weekly basis. Able to process claims for all payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.)
Assures all assigned claims meet clearinghouse and/or payer processing criteria. Able to process (level 1 and 2) and check claim status via phone/payer website. Payer response reports and rejection reports are worked timely and meet Departmental Productivity and Quality Review standards.
Assure appropriate and timely documentation of all account activity. Correspondence is handled appropriately.
Complete all assigned EPIC billing/claim edits and insure all required reports are filed timely and accurately.
Identify opportunities for revenue cycle performance improvements and report to management team.
Identify and report trends, assist in the development and deployment of training relative to trends answering phone calls from patients and insurance companies. Verify patient's authorizations and referrals are on file. Followed specific security rules and guidelines to protect sensitive data, including patient medical records.
Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
Contributed to development, planning and completion of project initiatives. Supervisor Credit Team
Falls Church, VA
Inova Health System/ Jun 2015 to Jan 2019
Major areas of responsibility include hiring, training, workforce planning, coaching, developing, and providing feedback to employees, continuous improvement of process and workflow.
Set goals for performance and deadlines based on company's vision and communicate them to subordinates.
Promote and encourage a safe and professional environment in all areas supervised. Lead people and processes creating an environment where employees can contribute their best.
Managed all reporting, documentation and recordkeeping requirements for department. Reviewed accounts for signs of fraud and non-payment issues. Kept fully updated on current regulatory environment and made proactive adjustments to meet changing requirements.
Conducted investigations and in-depth evaluations of customers for creditworthiness and potential risk factors.
Identified possible issues with credit systems and monitoring by streamlining processes ahead of time.
Created standard operating procedures and delivered training to credit personnel to improve operational efficiency.
Worked with management to evaluate credit strategies and develop improvements. Completed ongoing professional training to facilitate accurate and productive credit management.
Applied deep understanding of industry best practices and legal requirements to prevent critical incidents.
Team Lead Refund Specialist
Falls Church, VA
Inova Health System/ May 2012 to Jun 2015
Review patient accounts to determine the cause of overpayment and process refunds accurately and in timely manner.
Assigned to credit balance collection work queue, and investigates and resolves patient accounts.
Provide resolutions on credits based on knowledge of payer contracts and understanding of the specific requirements for each payer.
Review and analyze EOB's to determine any possible over payments made by payer and/or patient.
Perform cash posting duties to correct posting payments errors, processing write-offs, deductibles, co-pays and non-covered or denied amounts. Demonstrate problem solving skills and effective communication skills. Assists in working unresolved accounts reporting on the credit balance report. Used POS systems to receive payment or obtain credit authorization. Provided excellent service and attention to customers when face-to-face or through phone conversations.
Created agendas and communication materials for team meetings. Motivated and encouraged team members to communicate more openly and constructively with each other.
Juggled multiple projects and tasks to ensure high quality and timely delivery. Resolved interpersonal conflicts by listening, finding common ground and building relationships.
Refund Specialist
Fairfax, VA
Fairfax Radiological Consultants, P.C/ Jul 2011 to Apr 2012 Research and resolve billing issues and credit balance. Answer inbound calls from insurance companies and patients regarding overpayment issues.
Prepare refunds, adjustments, and related documentation for approval. Balance and reconcile assigned payment batch total on daily basis. Post daily payments, insurance payments, and miscellaneous payments. Be a team player and have good organization skills as well as demonstrating effective communication skills both verbal and in writing.
Workers Compensation Representative
Ashburn, VA
Nova Medical & Urgent Care Center Inc/ Oct 2004 to Jul 2011 Communicate verbally and in writing with injured employees, their departments, physicians, attorneys, Workers' Compensation Appeals Board members, and other interested parties; reviews established claims periodically to prompt action and closure, and/or settlement.
Generate revenue by making payment arrangements; collecting accounts; monitoring and pursuing delinquent accounts.
File and submit medical claims to appropriate insurance carriers or responsible parties. Review outstanding claims and process appeals for payment. Provide exceptional customer service to those contacted in the course of work. EDUCATION AND TRAINING
Associates Degree
Strayer University 1997
Alexandria, VA
High School Diploma
Bladensburg High School 1991
Bladensburg, MD
REFERENCES
REFERENCE Available Upon Request
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