Manager Insurance
Resume:
Donna Burgess
Nashville, TN 37221
Phone: 615-***-****
*******.*******@*****.***
SUMMARY OF QUALIFICATIONS
. Resourceful, organized team player with over 7 years experience in health
insurance audits
. Liaison for company by implementing new data placements, system access
and trouble shooting software issues
. Excelled in project/account management that involved working with
multifunctional teams
. Experienced in bringing providers and payors together when conflict of
contract interpretation arose
. Attended and facilitated meetings concerning data placements and
overpayment analysis
. Knowledgeable in auditing of medical bills for overpayments
. Proven ability to react fluidly to changing priorities
TECHNICAL HIGHLIGHTS
. Creation of automated system screen scrapes in eliminate need for manual
review of system
. Ability to work several internal/external proprietary software
applications; including claim processing systems
. Experienced in implementation of new clients and their data placements
. Involved in IT Scrums beginning with business needs to testing finished
product
PROFESSIONAL EXPERIENCE
October 2009 to
April 2011
January 2006 to
September 2009
AIM Healthcare
Franklin, TN
Client Service Manager
. Indirect management to over 30 client contacts and accountable for
reaching monthly revenue goals
. Worked with financial recovery department to automate tagging of
overpayments for all vendors which yielded automated paid vendor fees
. Collaborated with production team to implement client's VDSA file for COB
audits
. Implemented several new data placements due to claims processing system
migration and new enhanced data placements
. Fostered multiple departmental client relationships to ensure that their
needs and expectations were being met
. Lead several overpayment trending analysis conference call with client
. Proactive on client and internal communication to eliminate confusion and
lack of trust
AIM Healthcare
Franklin, TN
Account Manager
. Directly responsible for overpayment identification and recovery of eight
insurance clients
. Established relationships with client contacts to develop automated
processes on our end to eliminate overtime costs on their end
. Managed team of analysts responsible for monthly identification
overpayments on contractual and coordination of benefits
. Responsible for the life cycle of claims until accounts receivables were
resolved.
. Involved in analysis for new overpayment trends on contractual agreements
with providers
or due to coordination of benefits
December 2004 to
December 2005
AIM Healthcare
Franklin, TN
Senior Coordination of Benefits Analyst
. Partnered with training department to revamp new hires
training materials for COB analyst
. Client requested my experience in training another division
on coordination of benefits for their quality check
. Primarily responsible for meeting my $500K monthly
overpayment identification goal
. AIded other analysts to reach/exceed their client's monthly
identification goals
. Lead Point person for any coordination of benefits
questions or system issues arising from team of 15 peers
. Knowledgeable in NAIC and MSP guidelines and how to apply
November 2003 to
November 2004
AIM Healthcare
Franklin, TN
Coordination of Benefits Analyst
. Exceeded monthly $300K monthly overpayment identification goal on a
consistent basis
. After only a few months of identifying overpayments, management expanded
base of clients
. Called employers and members to determine primary insurance for Medicare
and/or commercial insurance
. Called MSP to update records or transfer REMIS information to CWF
EDUCATION
2002
University of Montevallo
Montevallo, AL
Early Childhood Education with Business
Alpha Delta Pi
volunteered with American Red Cross, American Exchange Club and Ronald
McDonald
House
COMMUNITY INVOLVEMENT
Hands on Nashville Project Leader, American Red Cross
AWARDS
United Healthcare Group's 2010 SPOT award
Contact this candidate