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Insurance Management

Location:
San Bernardino, CA, 92404
Posted:
September 09, 2010

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Resume:

Connie Smith

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

San Bernardino, California 92404

H 909-***-****

C 951-***-****

ablcac@r.postjobfree.com

SUMMARY

An excellent problem solver and detail-oriented business professional

with extensive experience in Pharmaceutical Operations, Customer

Relations, and collections. Takes on increasing challenges with

proven results that exceed management's expectations consistently.

EXPERIENCE

TLC Staffing

St. Bernardine Medical Center

San Bernardino, CA

Collector

2010-2010

Held responsibility for resolution of collections issues associated with

insurance claims submitted on UB-04, appeals, resubmission of claims and

adjustment's for all commercial insurance carrier's and Managed Care Medi-

Cal. Assisted in training of new temps. Assisted with all incoming mail by

opening and distributing to correct employee for Patient Financial

Services.

Office Works

Casa Colina Hospital and Rehab Center

Pomona, California

Collector

2009-2009

Held responsibility for resolution of collections issues associated with

insurance claims submitted on UB-04 & CMS-1500, appeal's, resubmission of

claims and adjustment's for all insurance carrier's, including Medicare,

Medi-Cal, and worker's compensation for Team's; Neuro Psych, LTC, I/P

Hospital Services & Residential, Outpatient Therapy. Adult Day Health,

Sleep Center, Ortho Therapy, Audiology, Radiology, Adolescent Therapy,

Autism and Infant-CRT based and In Home. Held responsibility for

collections associated with patient billing, payment plans and charity

applications.

CVS Caremark Redlands, California

Collection Representative I 2005 - 2009

Held responsibility for researching resolution of complex collections

issues, situations, and problems associated with payers and contracts on

daily basis. Reviewed contractual agreements to understand billing and

collection requirements and identify issues that may negatively impact

reimbursement. Worked closely with management, sales, variety of

professionals, finance, and regional collections areas to resolve

identified issues and collect outstanding balances. Responsible for all

collection activity to ensure timely and accurate reimbursement for

assigned accounts. Successful completion of this assignment required

ability to effectively prioritize large number of invoices to ensure

completion of all billing and follow ups within guidelines established by

management, rebilling of claims, initial claims not on file with payer, and

completion of appeals and re-determination requests as required. Presented

completion of reporting to management detailing all collection efforts,

account statuses, and potential account issues.

Loma Linda University Health Care Loma Linda, California

Financial Counselor / Ops Support / Collector 1995 - 2005

Responsible for resolution of collections associated with insurance claims

and adjustment for various insurance carriers, including Medicare, Medi-

Cal, workers compensation, HMO, PPO, and IPAs. Worked large projects for

management diversely, in all areas of office, to provide back up wherever

needed. Covered open positions, posted payments, and handled incoming

patient phone calls. Researched and resolved payment discrepancies based

on contractual agreements.

Team Lead 1998 - 2002

Directed team of 20-25 employees in assisting with various duties, e.g.,

authorizing adjustments, handling patient phone calls, and training new and

existing employees. Also held responsibility for fertility and pre-

employment accounts. Assisted in interviews for potential new hires.

Primary duties involved assisting supervisor whenever needed in various

duties, overseeing team of employees, training new employees, authorizing

adjustments, handling patient phone calls, and tracking infertility

accounts and pre-employment accounts.

ADDITIONAL EXPERIENCE

Watson Medical Lab, San Bernardino, California, Collector, 1989 -

1996. Held responsibility for all private insurance claims for

collections, bank deposits and bank runs, and entering test results.

EDUCATION

American Academy of Professional Coders

Certified 05/23/2010

Summit Educational Services, San Bernardino, California

Certificate in Excel and Word, 1994

SKILLS

Microsoft Excel, Word, and Outlook



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