Manuel Ismael Bank

*** ****** ***** *****, *** *E

Fort Lee, New Jersey 07024

Phone:646-***-**** (Cell#)

E-mail: ac06ba@r.postjobfree.com

Key Qualifications

Substantial experience in medical billing, data processing and claims submission Profound knowledge of medical terminology, codes applicable in CPT, ICD-9, ICD10, Rev codes and HCPCS systems, DRGs, Health Maintenance Organization (HMO) and IPA claim payments adjudication.

Deep knowledge of benefit plans and processing of medical claims Familiarity about universal billing forms and billing processes in electronic system

Solid understanding of claim processing for healthcare industry

Proficient with Facets, Sax, Kofax, Basys, Encoder pro, Alchemy, Meaco, MCO, Case trakker, Xifin applications, Tartan and Targon data entry softwares and Microsoft Office products

Ability to respond to customers’ requirements in adherence with company policies

Ability to complete assigned multiple tasks effectually in changing environment

Ability to process claims (Outpatient & Inpatient) for surgery, radiology, labs, amb surg, orthothics, DME, Emergency, Physical therapy, MLTC and medicine for CMS 1500 and CMS 1450 claim forms

Solid understanding of the Appeals, Correspondence and Customer focus process.

Experienced on FFS, APG and provider reimbursement fee calculation based on provider contracts

Experienced on Late fees, Replacement claims adjustment

Experienced on COB, EOP process for provider reimbursement

Ability to key stroke at 12,000 KPH with 97% accuracy

Solid understanding of computer literacy

Experienced and solid understanding of interpreting and handling medical records for the appropriate claims adjudication

Experience

Medical claims analyst, (Temporary contract) Apr 2016 – Jul 2016.

Lighthouse Guild Health & Vision/Guildnet, 15 W 65th St, Ny, Ny

Assigned to review authorization denials for Home care & Nursing

Homes care services (MLTC) toward resolution of payment to the providers

Medical claims examiner, (Full-time) Jan 2015 - Dec 2015.

Europ Assistance, Bethesda, MD.

• Accurately evaluate, regulate, and pass judgment of Medical claims in a timely manner

• Research and take action in response to telephone and written inquires

• Enter and check over claims into system

• Send system generated letters to providers.

Medical claims analyst, (Full-time) Oct 2001 - Aug 2014.

Health Plus-Amerigroup, Wellpoint Inc, 241 37th st, Brooklyn, Ny 11214.

• Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements

• Entered claims data into system

• Resolved problems resulting from claim settlement

• Performed audit of randomly selected claims to ensure quality processing

• Researches claim overpayments and requests funds

• Followed adjudication policies and procedures to make sure proper payment of claims

• Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims

• Logged telephone calls in system and followed up on issue

Interacted with Model office, Enrollment, Member services and Provider relations department for the proper adjudication of the claims

Student Application Coder & Processor.

U.A.P.C, City University of New York at Kingsborough Community College, Brooklyn, Ny.(Full-time) Oct 1998 - Oct 2001.

Data Entry & Codification of national & foreing student applications

Performing & testing field end edit programing in Tartan Cobol-Basic based data entry software.

Education

Labcorp Corp., Ny, Ny,A-plus, Windows NT networking, MS Office 2000, Excel, Access. 2000 - 2001.

Instituto Tecnologico De Santo Domingo (University). Dom. Rep.

Computer System Engineer, 1982 - 1986.

Quality Control Supervisor Training course, Field end edit programming & editing etc. Medical Claims training,Value tables editing training etc. 1988- 1993.

References

Ada Bekker.

Lighthouse Guild Health and Vision, Provider relations department director, 212-***-****

Anshumalit Dixit.

Europ Assistance, Claims department director, 240-***-****

Nancy Rosado.

Health Plus Inc-Amerigroup-Wellpoint Inc, Claims department director, 917-***-****

Aguida Garcia.

Health Plus Inc, Claims Department, Correspondence unit representative, 347-***-****

Donna Dritto.

Health Plus Inc, Claims Department, Correspondence unit representative, 718-***-****

Contact this candidate