Insurance Manager

Rebecca A. Nilles

*** ******* ****** **** *****, IL 60137

***********@*****.***

630-***-****

Summary

I am a highly experienced and accomplished multi facility manager with an

extensive background in provider relations, resourcing, training, and

business operations.

Professional Background and Accomplishments

Provider Relations

. Strong end to end knowledge of contracting, credentialing, and network

maintenance.

. Negotiated all fee schedules and fee schedule enhancements for general

dentist and specialty care for highly utilized procedure codes.

. Conducted yearly facility and patient record reviews to ensure

insurance company compliance.

. Implemented process for inner office auditing to maintain compliance

with providers requirements.

. Liaison with dental malpractice insurance carriers regarding liability

issues for treatments.

. Served as a primary contact between insurance companies and providers.

. MS office knowledge (Word and Excel), Internet skills (Internet

Explorer, Firefox, and Chrome), PC Literacy (Windows XP and Windows

7).

Staff Management/Resources

. Composed and implemented staff Standard Operating Procedures (SOP)

manual.

. Conducted training, orientation for HIPPA, and OSHA standards.

. Instituted staff hepatitis vaccine program.

. Trained staff for managed care copayment structures, flex account

management, exclusions, waiting periods, referrals, and claim

submissions.

. Responsible for hiring and firing all staff.

Insurance

. Procured all beneficial insurance programs, HMO, PPO, and FFS for

office participation.

. Negotiated fee Schedule enhancements for highly utilized procedure

codes.

. Managed all aspects of claim submission, reconciliations and encounter

form data errors.

. Conducted facility reviews and patient record reviews with insurance

provider relations representatives.

. Ability to evaluate managed care data trends for utilization and

treatments rendered.

. Insurance policies and procedures knowledge.

Employment History

Camden Dental, LTD 1971 to 2009

132 Addison, Elmhurst IL 60126

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