Judith R. Overstreet**** *********** **
Nashville, TN 37207615-***-****
Background in Management, Purchasing, Fraud Investigator, Public Relations & Customer Service Manager. Resourceful problem-solver, skilled in identifying and meeting needs. Able to work well independently and achieve objectives. Quick study I welcome new challenges.
HIGLIGHT OF QUALIFICATIONS
Project & Quality Management Insurance Claims Utilization Review
Buying/Negotiations Insurance Claims Fraud Investigator
Inventory Management Client Service and Relations
Customer Service Manager/Purchasing Agent: Handled customer calls concerning, pricing, order delivery or any account payable issues...Designed and supervised the programming tracking system for customer services. Responsible for buying & negotiating purchasing programs and for development and application of marketing strategies for our products. Conducted and coordinated presentations for monthly sales meetings. Others duties included meeting financial results, weekly monthly reports and market survey/planning. Experience in inventory management and cost control…Achieved Customer Service Award
Medicare Fraud Department: Primary communicator to the Health Care Financing Administration on issues related to Health Care Fraud & Abuse. Established and maintained ongoing communication with federal government agencies, law enforcement and private organization concerning healthcare fraud issues. Arranged and facilitated healthcare fraud task force meetings. Coordinated information with other insurance carriers to identify and investigate fraud & abuse activities. Trained Physician and office staff on Medicare Compliance issues. Working knowledge of federal and multiple state regulatory compliance standards. Conducted fraud & abuse educational outreach training programs for Medicare Part B employees and also with the Medicare Part A carriers…Achieved CIGNA highest employee recognition, the PRESIDENT CLUB AWARD for developing the fraud training program.
Managed Care Organization: Managed Customer Service Department. Management responsibilities included the hiring, training, planning assigning and distributing the workload. Assisted in addressing customer complaints and established action plans to resolve the issues. Directed and established operational policies to ensure compliance with all federal, state and local regulation. Experience in HMO/Managed Care contracts and payment methods. Conducted claim audits and reviewed data analysis. Establish and maintain effective interdepartmental relationship with Claims Department, Utilization Review, Medical Records and Accounting Department.
High Dollar Collection Specialist: Follow-up on all unpaid health insurance claims. Resolve medical claims billing issues & underpayments. Knowledge of deductibles, co-pays, out of pocket expenses and collecting from Commercial, PPO, HMO, Medicare & Medicaid payors. Knowledge of HIPPA regulations.
HCA April 2003 – Current Nashville, TN
Supply Chain Customer Service Call Center – current
Purchasing Agent July 2005- January 2007
Collection Specialist April 2003 – July 2005
Progressive Health Care August 2002 – April 2003 Brentwood, TN
High Dollar Collection Specialist
Pioneer Medical, Inc. (Part-Time) September 2001 – August 2002 Nashville, TN
Medicare Collection Specialist
Theraphysics, Inc. July 1998 – May 2001 Brentwood, TN
Customer Service Manager
Cigna Medicare Administration February 1990 – February 1997 Nashville, TN
Medicare Fraud Information Coordinator/Investigator
Robert Orr/Sysco Food Services 1982 – 1989 Nashville, TN
Volunteer State Community College
• Currently 2 ½ years toward an Associate Bachelor’s Degree in Business Management
• Managed at different times from 5 to 15 employees
• Public Speaking, Training & Trade Show Experience
• Collections Systems, Host, Smart, Remdy, Onbase, Outlook, Windows, Excel, GHX, Meditech
References Available Upon Request