Insurance Manager
Resume:
Michael James Harris
Stone Mountain, GA 30088
***************@*****.***
770-***-**** Home Phone
404-***-**** Cell Phone
Objective & Goals
To join a successful medical office setting using my 10 years of experience in management.
Software Knowledge
GE Centricity Oracle accounts payable
Micro MD Kronos Payroll
Mysis (Tiger version) ADP Payroll
Advantx Microsoft Excel
El-comp Microsoft Word
Medical Manager Microsoft Outlook
Insight Lotus Notes
Accum-Term Doctor First
SRS Clinical Management (EMR system) NextGen
Skills Highlights
Effectively manage multiple client issues in a timely and efficient manner
Exceptional customer service and problem solving patient complaints and inquires
Display a high degree of motivation and the ability to work independently
Ability to implement policies and procedures and decision-making skills
Full cycle Hospital/Physician billing procedures (coding, claims, payment posting, insurance follow up and
collections)
Medical Assistance Background
Excellent English language, oral and written communication skills
Adept with HR and Payroll Procedures
Adhere to all HIPAA regulations and maintain the strictest of patient confidentiality
Knowledge of NSF or ANSI X12 formats including 837 (professional, institutional and dental) and 835 as well as
997 and 277 transactions.
Ability to manage multiple priorities in a fast paced environment.
Strong communication and analytical skills.
Proven ability to work in a team environment
Human Resources functions
Negotiations of Insurance Contracts
Payroll Functions for over 20 employees
EMR system knowledge (Allscripts, Phoenix, & SRS)
Employment History
Healthcare of America 05/2009-
Present Billing Manager
Atlanta, GA
Responsibilities and Duties:
• Overseen Billing functions for (7) seven physician offices in the Atlanta area.
• Supervised a team of (20) employees
• Providing coding updates to assigned facilities and/or physician offices
• Assured accuracy of daily payment posting and write-offs functions.
• Assured accuracy of daily payment posting and write-offs functions.
• Submit claim files to clearinghouse, review 997 for rejected and accepted claims.
• Work Level 2 reports from insurance company for rejected claims and resubmissions.
• Monitor received explanations of benefits from insurance carriers.
• Work Level 2 reports from insurance company for rejected claims and resubmissions.
• Monitor received explanations of benefits from insurance carriers.
• Reviewed note entries entered by Accounts Receivable Representatives to assure proper follow up functions are
performed to prevent denials for billed claims.
• Reviewed all denials
• Establish medical necessity for denied claims
• Coding functions
• Running of Monthly A/R reports
• Reviewed aging categories reflecting outstanding dollars
• Performed Month end and Year end reports
• Negotiation of Insurance Contracts
• Credentialing
Resurgens Orthopedic Surgical Center 09/1996 –
04/2009
Business Office Manager Atlanta,
GA
Responsibilities and Duties:
• Managed, coordinated and directed all medical and non-medical functions in the Front office in an outpatient
surgery setting
• Oversaw Patient Scheduling and Registration functions
• Managed Front desk check-in, the collecting of co-pays, co-insurance, and/or deductibles, and posting of
surgical procedure charges, diagnoses codes, as well as CPT codes according to surgical charge form/sheet
• Assured that Referrals were collected and completed correctly
• Oversaw patient financial consulting, patient payment plans/arrangements, as well as insurance verification and
authorization process with insurance carriers for scheduled surgical procedures
• Assured accuracy of daily payment posting and write-offs functions.
• Submit claim files to clearinghouse, review 997 for rejected and accepted claims.
• Work Level 2 reports from insurance company for rejected claims and resubmissions.
• Monitor received explanations of benefits from insurance carriers
• Performed Month end and Year end reports
• Human Resources functions
• Negotiation of Insurance contracts
• Credentialing
Education:
High School: Greater Works Academy, Pittsburgh, PA
Institution: Medical Assistance Program, Duff’s Business Institute, Pittsburgh PA
References available upon request
Contact this candidate