Insurance Management
Resume:
Shanita Moore
*** ******** **** | Riverdale, GA *0296 | 404-***-**** |
***************@*****.***
Objective
Seeking a challenging position in healthcare that allows me to contribute my skills and experience in achieving organizational
goals.
Skills Profile
- Excellent attendance record
- Ability to grasp new concepts quickly and synthesize information.
- Team Player
- 12 years experience in healthcare field.
Employment History
Patient Collections, Accountemps 7/1/2012 10/31/2012
Riverdale,GA
Follow up on insurance claims filed
Rebill claims that denied due to bill errors
Bill claims
Process Refunds
Account resolution
Rectify COB issues and submit additional information maintaining HIPAA regulations.
Patient Collections
Managed Care Anlyst, Bottom Line Systems 2/14/2011 1/13/2012
Atlanta, GA
Work autonomously reviewing insurance contracts to gain understanding of payment methodologies.
Examine Claims and calculate reimbursement based on contract terms to determine accuracy of payment received.
Contact insurance companies in order to request payment on claims which are underpaid.
Submit appeals in order to overturn denials of payment when necessary.
Knowledge of healthcare financial case management & managed care.
Post payments and adjustments
Report, identify, and communicate trends in payments and denials to upper management.
Build strong relationships with clients and payers.
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Overpayment Analyst(Promotion), HCA 4/11/2005 3/11/2010
Norcross, GA
Analyze claims for possible overpayments.
Read and interpret managed care contracts in order to determine if proper payment
Process necessary refunds according to CIA guidelines.
Maintain SOX compliance while identifying discrepancies and initiating refunds. Distinguish, report, and correct
overpayment trends. Monitor insurance offsets and initiate communication between facility and insurance
company as needed to correct variance.
Review all documentation related to payments. Where appropriate, negotiate and coordinate efforts with vendors
and other departments in order to resolve any problem relating to delinquent or disputed reimbursements.
Advise and instruct internal and external customers on discrepancies, incomplete, or incorrect documentation.
Communicate clearly and concisely with management and insurance companies in order to alleviate discrepancies.
Transfer misapplied funds.
Calculate patient liability based on correct contract rates.
Calculate DRG’s.
Utilize clear claim connect to determine primary procedures.
Worked with managed care payers in order to identify trends and correct erroneous payments. Prepared reports of
findings and presented them to upper management.
Support revenue cycle by identifying underpayments and system errors.
Prepared documentation for audits.
Analyze workers comp claims and contact payers to determine proper insurance reimbursements.
Government Refunds Analyst, HCA
Norcross, GA
Process refunds to government payers.
Complete Medicare quarterly report.
Document refunds in CRT.
Use MSC to determine how claim processed.
Void Medicaid claims.
Interpret government regulations
Process patient refunds and transfer patient payments.
Utilize web portal to determine correct claim processing.
Review claims for proper submittal.
Assist with month end accounting reports.
Experience in billing Medicare A & B, Medicaid, 3rd party payers
Education
- B.S. Healthcare Management* Bellevue University
- A.A. Letters, Arts, Science * Antelope Valley College
- CPAR Certified
Proficiency Using
Microsoft Software
DEI
Artiva
HOST
Payer Facts
Healthquest
Medik
Z irmed
Contact this candidate