Manager High School

L au ra Say Nowak

**** ****** ****** *** #*** * Orlando, Florida 32810 * (716) 983 – 7483 * *******@*****.***

Profile

Proficient in MS Word, Excel, PowerPoint, Outlook, and Lotus Notes.

Detail-oriented, driven to succeed to my fullest potential, excels at multi-tasking in a fast paced environment.

Solid background in administrative roles, including F ront Desk Reception experience, as well as, superior knowledge

i n different areas of the health care industry, including billing and insurance.

Experience

BlueCross BlueShield of Western New York

257 West Genesee Street

B uffalo, New York 14202

(716) 887 – 8493

M edical Claims Processor – p rocess claims for Government Programs and Outpatient Facility, attach referrals and

authorizations to claims, follow specific policies and procedures for each particular claim, complete adjustments, process CDH

reimbursements, request desk level updates on an as needed basis, follow all rules and regulations of HIPAA and report any

possible violations, knowledge and experience with ICD-9 codes, procedure codes, medical billing, Facets, Pega, Online Rates, Code

& Comment, Covering Provider Database, Word, Excel, Outlook, and Lotus Notes

October 2008 – July 2010

M anager - Robyn Burke / Kelly VanSlycke

Palladian Health (f/k/a P rism Health Networks)

2732 T ransit Road

West Seneca, New York 14224

(716) 712 – 2700

Senior Claims Analyst – p rocess medical claims for several lines of business (Blue Cross Blue Shield, HIP, Vytra, Univera,

F lexcare, GHI, etc.), analyze referrals and authorizations, experience with ICD-9 codes, procedure codes, and all areas of HCFA’s,

i nvestigate grievances for providers and members, weekly auditing for H IP, Univera, and Vytra, return claims to providers if

m issing or incorrect information is present on the HCFA, run adjudication process for 2 lines of business, train new staff members,

assist manager in any special projects as needed, assisted with 2008 Policies and Procedures Manual for providers and employees,

assisted in training seminars for HIPAA, use Word documents and Excel spreadsheets for auditing and grievances, create

PowerPoints for presentations

July 2006 – September 2008

M anager - Roseann MacAlpine Lureman

Hoag Hospital

O ne Hoag D rive

N ewport Beach, California 92663

(949) 764 – 4624

M ember Relations Representative – answer a wide variety of customer related calls in a call center environment, verify status

of claims and referrals, send adjustment requests to other departments when errors are found (claims / referrals), problem solve

w ith customers and doctor’s offices, document every call in computer database by description of call, enter member referrals in

computer system, record any customer / provider complaints, investigate nature of complaints, compose reports on each complaint

for management to follow up on

July 2004 – May 2006

Manager - M ary Deacon

J. P. Rhoades Development

1801 – C Parkcourt Place

Santa Ana, California 92701

(714) 972 – 9944

F ront Desk Receptionist – answer all incoming calls for business, greet clients, schedule appointments and meetings, open and

d istribute all incoming mail, type all checks for business, take daily deposits to bank, type and edit final contracts for Vice President

and President of the company, weekly inventory of office supplies, order office supplies on an as needed basis, invoicing, create

PowerPoints for company meetings, data entry using both Excel and Word, copying, faxing, numerical and alphabetical filing

July 2003 – July 2004

M anager - Kelly V. Hansen

Education

Attica Central High School - A ttica, New York - Graduated June 1995, High School Diploma

N ew York Institute of Massage - W illiamsville, New York - Graduated October 1996, Licensed Massage Therapist

Genesee Community College - Batavia, New York - completed two semesters May 1998, English Major

Contact this candidate