Medical Manager

Karen M. Borgias

**** *. ******* ******

Mesa, Arizona 85206

847-***-**** abjuzr@r.postjobfree.com

Highly organized healthcare and medical claims professional with 20+ years

of experience in a variety of professional settings. Recognized for

expertise in all areas of medical claims. Effectively managing all levels

of customer and health plan interactions.

CAREER PROFILE:

. Successfully works independently and in a team environment

. Dedicated individual achieving a reputation for consistently going

beyond what is required

. Detail orientated and resourceful in the completion of tasks with

ability to multi task effectively

. Superior communication and interpersonal skills

. Excellent figure aptitude

. Demonstrates ability to manage daily work volume and special projects

. Extensive knowledge of managed care, medicare, personal injury, and

workman's compensation claims

. Strong analytical problem solving skills

PROFESSIONAL EXPERIENCE:

6/06-Present

Participant Advocate: Hewitt Associates, Lincolnshire, IL

. Assisted participants with navigating the healthcare system with

issues regarding claims and access to care

. Responsible for collecting and documenting participant information

concisely, resulting in initiating an average of 130 workflows per

month

. Conducted thorough research and follow up within the appropriate

timeframe

. Maintained a superior quality rating of 95% and above on call and

document audits

. Selected by supervisor to assist with special projects

9/97-4/06

Medical Collections Representative: Dr. Thomas Bennett, Libertyville, IL

. Implemented system for electronic claim submission of HCFA 1500

. Solely responsible for collecting $50,000-$60,000 per month from

health plan and patient payments

. Reviewed explanation of benefits and interacted with health plans to

resolve delayed claim payment issues

7/93-3/97

Front Desk Receptionist: Dr. Keith Potetti, Chicago, IL

. Scheduled appointments and maintained up to date patient files

. Responsible for insurance verification

. Management of medical record requests

. Oversaw the maintenance and purchase of office supplies and equipment

7/79-2/86

Medical Claim Adjuster: Electrical Insurance Trustees, Chicago, IL

. Investigated and processed complex medical claims

. Determined eligibility for short term disability claimants

. Assisted in mail distribution and filing

EDUCATION:

. 9/75-6/79 Carl Schurz High School

. 6/97 Certification in Medical Manager

. 9/97-4/06 Completion of HJ Ross Seminars and Integrity Management

Seminars

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