Insurance Microsoft Office

Professional Profile

An organized and seasoned Health Care Investigator with more than 20 years of diverse business experience; with strong analytical, leadership, management, communication, and decision-making capabilities. Proven record of outstanding problem-solving skills and the ability to comfortably meet deadlines and adapt to changing environments.

Experience

June 2004 to April 2017 - Kings County Hospital Center - Brooklyn, NY

12/2013 to 04/2017 - Supervising Hospital Care investigator (patient accounts)

Managed and coordinated all activities of staff in the assigned unit.

Supervised Senior Hospital Care Investigators in charge of individual units conducting investigations to determine eligibility and/or reviewing applications for medical assistance.

Planed and coordinated staff schedules and assignment to assure maximum utilization of available personnel.

Established adequate statistical controls and data in the assigned area.

Supervised training programs; interpreted policy, rules, and regulations for the guidance of staff.

Served as a case consultant and direct the investigation of difficult cases.

Prepared detail reports on workflow and performance of the unit, evaluated staff and recommended appropriate disciplinary action whenever necessary.

Reviewed cases submitted by subordinates.

Responsible for timekeeping entry and maintaining timesheet information.

Ordered office supplies and equipment through organization systems.

Facilitated creation of training programs for staff to ensure efficient performance of departmental programs and services.

10/2007 to 12/2013 – Senior Hospital Care investigator (patient accounts)

Conducted in-depth financial investigations to determine patient’s eligibility for Medicaid.

Updated patient’s demographic, insurance information and other contact data into the computer system.

Obtained all necessary payer authorizations and acquired all appropriate referrals for services rendered.

Recertified patient’s insurance coverage whose government insurance (Medicaid) has expired.

Assisted patients with questions or problems regarding insurance coverage and other financial issues.

Reviewed cases submitted by subordinates.

Explored alternate sources for payment for hospital services rendered.

Conducted special emergency, difficult and complex case investigations.

Performed billing and collection related functions in order to maximized hospital’s revenue.

Maintained statistical records and prepare reports.

06/2004 to 10/2007 – HOSPITAL CARE INVESTIGATOR - (PATIENT ACCOUNTS)

Conducted in-depth financial investigations to determine patient’s eligibility for Medicaid.

Obtained all necessary payer authorizations and acquired all appropriate referrals for services rendered.

Recertified patient’s insurance coverage whose government insurance (Medicaid) has expired.

Verified, modified and coded demographic and insurance data obtained from source documents and entered such data into a computerized system.

Updated patient’s demographic, insurance information and other contact data into the computer system.

Interviewed patient or patient’s family member to obtain/verify demographic information & insurance coverage.

Completed Magi and Non-Magi Medicaid application for patients without medical coverage.

Obtained patient’s signature on all insurance assessment forms and agreement such as Consent, External Appeal and Medicare Questionnaire forms.

Performed billing and collection related functions in order to obtain maximization of

Hospital’srevenue.

Performed related functions.

Education

MS - Community Health - Long Island University School of Health (2009)

BS - Business Management and Finance – CUNY Brooklyn College (2006)

Skills

Platforms: Windows XP/2000/NT

Software: Omnipro, Canopy, Webterm, Telnet, Quadramed, Ras, Edm, Mainframe, Emevs,

Epaces, Microsoft Office Suite, WMS subsystem.

Strong leadership, management, and interpersonal skills.

Excellent knowledge of the terms and regulations of Medicare/Medicaid.

Ability to check, arrange, and evaluate extensive and complex medical records.

Skilled in reviewing and planning case strategies and identifying heathcare fraud schemes.

Comfortable with irregular hours and working on weekends and night shifts.

Highly professional, cultured, patient, and matured person.

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