Medical Insurance

Monique R. Morris

*** ********* ******

Jersey City, NJ 07304

Phone: 201-***-****

E-mail: ********@*****.***

OBJECTIVE: To obtain a position in the Healthcare industry that

incorporates my excellent communication, interpersonal and

organization skills, problem -solving and analytical

ability.

EXPERIENCE:

06/18/2007 TO 01/27/2011

FRESENIUS MEDICAL CARE

ADMINISTRATIVE SECRETARY

. Operate a personal computer or word processor utilizing the appropriate

software to perform required duties such as: the taking and transcribing

of dictation, the completion of various forms and compiling of reports as

required by governmental agencies and the Corporate Office.

. Coordinate and maintain personnel records. Monitor attendance and PTO

records, Leaves of Absence and FMLA procedures and files. Initiate forms

required for salary actions and other personnel HRIS record changes;

coordinate and perform payroll preparation function; maintain payroll

records.

. Prepare various reports, which may include but are not limited to,

monthly insurance reports to Corporate Office, annual employee data

sheet, and monthly listing of employees by position.

. Complete and file Workmen's Compensation reports.

. Set up and maintain filing systems including census records of patients

and employees.

. Update manuals as necessary.

. Screen and direct the Clinic Management Team's (and other) telephone

calls; make travel arrangements for the Clinic Management Team; arrange

conferences and meetings.

. Take minutes for the Governing Body and Medical Staff meetings; compile

CQI data.

. Perform secretarial/receptionist functions as needed. These functions

may include, but are not limited to, greeting and directing patients and

visitors to the appropriate location; sorting mail; photocopying, faxing

and filing; preparing purchase orders using appropriate software;

maintaining an inventory of office forms and supplies.

. Assist with accounts receivable and accounts payable functions where

necessary.

. Support staff in assigned project work.

. Review and comply with the Code of Ethics and Business Conduct and all

relevant Company and Business Unit policies and procedures, and local,

state, and Federal laws and regulations.

. Ensure that employees understand and comply with the Code of Ethics and

Business Conduct and all relevant Company and Business Unit policies and

procedures, and local, state, and Federal laws and regulations, and

establish effective internal systems and controls to promote such

compliance.

08/2005 TO 6/16/2007

HOOPER HOLMES, Inc.

CREDENTIALING COORDINATOR

. Temporary supervise a team of four employees.

. Develop and manage medical database in a web-based environment.

. Receive and process all initial credentialing and re-credentialing

applications for council chair review and approval.

. Following up on clinical concerns, and processing quality data.

. Verify medical professional credentials through the National

Practitioners Databank, State License and American Specialty Boards.

. Re-certify existing medical professionals.

. Scanning (SNE) - scan no edit of all applications as well as up-

loading and linking documents to computer applications.

. Assist medical professionals with questions and concerns.

. Ability to accept new projects and assignments as they become

necessitate.

. Entering demographics, insurance and licensing information into the

database.

. Making necessary calls in order to verify all provider licenses are

current.

. Document all findings.

. Fax all necessary information to providers.

. Prepare credentialing list for council chair review meeting.

. Work directly with Credentialing Supervisor, communicating on all

issues and development.

. Develop and implement process for tracking credentialing and re-

credentialing providers, mailings through the 30 day workflow to

ensure compliance with 3 year cycle.

. Ensure provider notifications and committee results are processed

within 10 days of approval. Oversee all aspects of department mailings

and projects.

. Coordinate preparation and mailing of approval packets as providers

are added to the network or re-credentialed within workflow timelines.

Maintain Current Provider materials.

. Ensure compliance with HIPAA guidelines, to include filing of provider

files in a timely manner.

. Periodic audit and reconciliation of credentialing database.

. Assist with preparation for credentialing audits as necessary.

. Strong understanding of Credentialing protocols and URAC guidelines.

4/2003 TO 07/2005

EBI, LP / EBI HOLDINGS

PATIENT SERVICE REPRESENTATIVE

. Responsible for processing and adjusting paper, electronic

& scanned paperwork.

. DME billing and collection for all insurance's (HMO's, PPO,

POS, Workman Comp etc)

. Review submissions files to make sure they have all the

necessary forms and chart notes for submission to Medicaid

for payment.

. Input complete billing instructions into the AS400 system

and Filenet.

. Insurance verification by it self this can cover-type of policy,

effective date of coverage, deductibles/DME Limit's, prior

authorization and timely filing and billing address for claims

processing.

. Production of Units - shipping all valid orders by shipping codes.

. Requesting and reviewing clinical documentation.

. Setting up Prior Authorization file with state and local insurance

carriers.

. Review open files on a weekly or bi-weekly basis.

. Correspond with Sales Reps in the field regarding patient inquires (50

States plus International).

. Review Denials and follow-up on Appeals pending review by insurance

carriers.

. Finalizing patient accounts between 30 - 45 days.

. Review of all Patient Service Grids.

. Attend training seminars hosted by outside vendors on Anatomy,

Medicare and Negotiations.

. Contact with third party payers, this includes all Commercial, HMO,

Medicare, Medicaid, No Fault, Workers' Compensation and Attorney

offices.

. Team trainer/coordinator for new hires for Medicaid and

Medicare claims.

5/2002 TO 7/2005

BERKELEY HEIGHTS EMO

PATIENT REGISTRAR (Part Time)

. First point of contact for patients regarding scheduled appointments.

. Responsible for accurate, efficient, and timely registration of

patients' demographic information for department.

. Collect up front financial information required for accurate facility

billing.

. Coding and abstracting diagnosis in procedures using ICD9 and CPT

classification systems.

. Input of CPT& ICD9 billing codes for electronic billing.

. Confirmation of patients' appointments.

. Process patients through computerized system; prepare patient charts

and serve as a liaison between patient and medical support staff.

11/2001 TO 4/2003

SUMMIT MEDICAL GROUP, PA

PATIENT REGISTRAR (Part Time)

. First point of contact for patients regarding scheduled appointments.

. Responsible for accurate, efficient, and timely registration of

patients' demographic information for department.

. Collect up front financial information required for accurate facility

billing.

. Coding and abstracting diagnosis in procedures using ICD9 and CPT

classification systems.

. Input of CPT& ICD9 billing codes for electronic billing.

. Confirmation of patients' appointments.

. Process patients through computerized system; prepare patient charts

and serve as a liaison between patient and medical support staff.

2/2000 TO 7/2002

BERMAN LARSON KANE

(IT AND HR STAFFING FIRM)

CANDIDATE DEVELOPMENT ADMINISTRATOR

. Initial contact for many new candidates who reach Berman Larson Kane

through the Internet.

. Process all e-mail resume responses submitted in reference to job

descriptions posted on Net-temps and Monster message boards.

. Conduct a quick search in Proprietary database on all applicants

before forwarding potential candidates to recruiters.

. Strong skills in qualifying and skill matching new candidates to

current job openings.

. Pre-screen all potential candidates.

. E-mail Search Posting.

. E-mail Search Electronic Mail Pushes.

. Closed Search Electronic Mail Pushes.

. Updating candidates' screen.

. Meet and greet customers and clients.

. Operation of Switchboard - answering a 20-line switchboard and

directing calls to approximately 40 employees.

. Facsimile distribution.

. Back screens - installation of Internet or PC skills along with

general background information of education, years of experience,

salary and preference of work location.

. Scanning (SNE) - scan no edit.

. Approximately 25 applicants processed daily.

. Conduct a Pro-Search of all clients.

. Preparation of Resumes - reviewing of resumes including editing,

spelling and grammar checks, and font changes along with formatting.

. Documentation of Resumes - keeping a log of all resumes processed

daily and weekly.

. Approximately 100 or more applicant's processes weekly.

1998 TO 2000

NUTLEY PEDIATRIC ASSOCIATES

FRONT DESK RECEPTIONIST

. First point of contact for patients regarding scheduled appointments.

. Responsible for accurate, efficient, and timely registration of

patients' demographic information for department.

. Collect up front financial information required for accurate facility

billing.

. Coding and abstracting diagnosis in procedures using ICD9 and CPT

classification systems.

. Input of CPT& ICD9 billing codes for electronic billing.

. Confirmation of patients' appointments.

. Process patients through computerized system; prepare patient charts

and serve as a liaison between patient and medical support staff.

. Submit application for medical referrals.

. Follow-up with insurance companies on unpaid accounts and referrals.

. Monitor, review and evaluate insurance claim denial and take

corrective actions to get them paid.

EDUCATION: Kaplan University

BS - Management

Expected Graduation: January 2012

Gibbs College Livingston, New Jersey

AAS - Office Administration

Graduation: June 27, 2008

Katherine Gibbs Montclair, New Jersey

Certificate: Medical Office Assistant

Graduation: December 23, 1998

MEMBERSHIPS: IAAP (International Association of Administrative

Professionals)

Morris County Chapter

Working knowledge of the following software's;

. Echo

. PCN

. NPDB

. Rally

. Clinstar

. Visions

. Medisoft

. PBS Software

. Ms Word

. Ms Outlook

. Filenet

. Lotus Notes

. Internet

. Ms Publisher

. Ms Excel

. SAP

. AS400

. Pro-Search

. Encore

. Medical Billing

. Medical Manager

. Medical Transcription

. CPT & ICD9 Billing Codes

. Kronos

. Proton

. PeopleSoft

. SIMS

.

Contact this candidate