Insurance Manager

PAULINE GREGORY

Houston, Texas 713-***-**** ********.******@*****.***

PROFILE

An experienced medical professional with over 8years of experience, as Certified Nursing Assistant (CNA/Caregiver), PT aid. Who currently trained in the certification program for Medical Billing and coding; One who has the drive and desire, to gain and offer acute knowledge in the arena of bookkeeping techniques, while implementing the soft skills of organization, data processing, research and operations.

SUMMARY OF QUALIFICATIONS

Proficient in CPT and ICD-9 and 10 coding principles, guidelines and terminology

Excellent customer service competency.

Strong written and verbal communication skills.

Ability to manage relationships with various Insurance payers.

Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement

Neat appearance; pleasant speaking voice and demeanor; positive attitude.

Responsible use of confidential information.

Microsoft power point.

Microsoft Excel.

Microsoft office.

Electronic Recording

Filing.

Vital signs.

Perform to company standards of compliance with policies and procedures

Ability to multi-task and work courteously and respectfully with fellow employees, clients and patients

DETAILED WORK ACTIVITIES

Verifies completeness and accuracy of all paper claims prior to submission

Timely follow up on insurance claim denials, exceptions or exclusions.

Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days

Respond to inquiries from insurance companies, patients and providers

Regularly meet with Account Manager to discuss and resolve reimbursement issues or billing obstacles

Regularly attend monthly staff meetings and continuing educational sessions as requested.

Perform additional duties as requested by Supervisory or Management team

EDUCATION

Houston Community College – Houston, Texas

Certificate in Medical Billing and Coding Specialist – Project Completed 2014

Flex Health Career Schools – Houston, Texas

Certificate in Nursing Aid (CNA) – 2010

Certificate in Prevention and Management of Aggressive Behavior (PMAB) – 2013

Houston community college – Associate in nursing degree(in progress) - 2016

CPR licensed - 2014

Penn foster career school - Certificate diploma in physical therapy aid- 2016-2017

PROFESSIONAL EXPERIENCE

Medical Rehabilitation Clinic – Dallas, Texas.

February 2009 to May 2009

RECEPTIONIST

Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies

Prepare and process refunds with necessary documentation and submit to Account Manager for approval

Responsible for mailing reminder notices and calling patients before scheduled appointments

Visiting Angels home health care - June 2009 to August 2014.

Brazos Presbyterian -September 2014 to May 2015

Certified Nursing Aid / Hospice Aid (CNA)

Kindred hospital houston Tx. February 2015 to May 2016

Garden terrace nursing home/rehab- June 2015 to July 2016

Smartliving home health care –February 2014 to date.

Administered and reminding medication to patients, as prescribed by physicians.

Notes and reporting of patients’ progress to case manager or charge nurse.

Helping with daily needs for the hospice and elderly.

Private homes care, Nursing or senior leaving homes and hospitals.

Recoding their in put and out put vitals, with meditech. Etc.

Experience in Orthopedic, eye and general surgery, pre-op and pacu care. Etc.

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