Medical Insurance

Kathleen C Degrassi

PHONE 630-***-****

abljn7@r.postjobfree.com

OBJECTIVE: Seeking an opportunity for employment, in a growing company,

that provides a variety of challenges that can utilize skills obtain in

the Insurance Industry.

PROFESSIONAL SUMMARY: Conscientious, independent worker, self-starter,

dependable, Aggressive, quick to learn, well organized with the ability to

get the job done.

SKILLS: Excel, Lotus Notes, Access and Word. Computer savvy Customer

Service Skills Physician Relations/ Credentialing Management / Supervisor

skills Senior Claims Auditor/ Claims Examiner Medical Terminology - ICD9

and CPT coding, UB04, HCFA 1500 Health Insurance, Manage-care, Medicare

and Medicaid

EDUCATION:

Illinois licensed Producer/Agent Health, Life, P &C Holder of the

Series 6 and 63 licenses. CLU designate: Personal Insurance

EXPERIENCES:

2003-2009 ARTISAN CLAIMS

CLAIM MANAGER VIRTUAL OFFICE

Managed and review of medical claims and records of Personal Injury claims

for the State of Alabama Louisiana, Pennsylvania, California and Texas.

Medical Necessity, PPO reduction, Negotiation for prompt payment.

Training of multi keyers ( Worked Two Jobs due to decline in husbands job

in Auto Industry)

2007-2008 MIDWEST ORTHOPEDICS INSURANCE REIMBURSMENT SPECIALIST-WORKERS

COMP

Collection of payment from insurance carriers for physician medical

services. Ensure specific payments were received based on contract

agreement. Appeal of charges based on review of EOB and medical records

and coding.

2006-2007 DUPAGE MEDICAL GROUP INSURANCE REIMBURSMENT SPECIALIST-

MANAGECARE

Collection of payment from miscellaneous insurance carriers for physician

services. Ensure specific payments were received based on contract

agreement. Appeal of charges based on review of EOB and medical records

and coding. Refunds due back to payor based on erronanous payment.

2005-2006 UNIVERSITY OF CHICAGO PHYSICIAN INSURANCE REIMBURSMENT

SPECIALIST

Collection of payment from miscellaneous insurance carriers for physician

services. Appeal of charges based on review of medical records,EOB and

codes. Refunds due back to payor based on erronanous payment. Worked with

all payors

2001-2003 GALLAGHER BENEFITS ADMIN TPA SENIOR CLAIMS ADJUDICATOR AND

AUDITOR

Funds Recovery Specialist, Auditor,Adjuster, Benefit specialist and Plan

Builder. RIMS SYSTEM administration of plan benefits based on diagnosis

and procedure for medical services. Plan building for automated computer

review and payment release. Appeal review with the use of medical records,

fee schedule and plan documents for additional payments. Refund review

request for erronaous payments.

1996 - 2001: CSI & CSRG

SENIOR CLAIMS SPECIALIS AND AUDITOR

Clean up of medical accounts for Multi carriers, start up of insurance

payers, Physician contracting for multi ppo networks, creation of work flow

for insurance mergers to take over companies.PPO repricing issues,

physician fee structure for payments. Review of policies and medical

records to resolve Appeals, collect erroneous payments lacking medical

soundness.

1992-1996: The Prudential

PRODUCER LIFE UNDERWRITER

Licensed financial adviser, assisted individual family establish a sound

financial plan for their future with the use of Prudential products.

Assessed financial straightens, liability,upcoming life events and health

situations.Rated policies, by reviewing medical records and wrote policies

suitable for individual situations.

PAST

ACCOMPLISHED EMPLOYMENT

TRAVELERS/ BENEFIT SPECIALIST Adjudicator for Chicago groups, liaison to

the policyholder,employees, and provider affairs.

EQUICOR/CIGNA BENEFIT SPECIALIST Adjudicator for State of Illinois

health plan administration of Health plan benefits.

HEALTH CHICAGO / SUPERVISOR TRAINER Start up/ pioneer of HMO plan in the

Chicago area. Supervisor of 12 adjudicators

LOYOLA MEDICAL/ PATIENT FINANCIAL REPRESENTATIVE Liaison for Blue Cross

and Blue Shield review payment structure for inpatient services.

Representative to the Chicago Hospital Council assisted with the design of

the UB structure.

LOYOLA MEDICAL/ ADMINISTER STATE FUNDING Liaison for State programs that

funded medical service at Loyola Medical Center, programs such as

Perinatal Program, Medicaid and Medicare.

OAK PARK HOSPITAL X-RAY TECHNICIAN

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