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Insurance Customer Service

Location:
Frederick, Maryland, United States
Posted:
March 05, 2018

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Margaret

Anyanso

AstraZeneca Prior Experience, as EMR/OSP/FTE

Manager

Start

End

NZID

Recruiter’s Summary/Comments:

Skills (List all skills relevant to this role): I have case management experience . Have extensive knowledge in the health field area regarding Medicare and Medicaid processing, COBRA, COB, HMO,PPO processing. Inpatient billing including outpatient billing. As a Case Manager, I was responsible for the financial planning of terminal ill patients. I was constantly in contact with healthcare officers to make sure that patients got their medications on time. Handled over 32 patient case load, provided reimbursement verifications and research to investigate insurance claims in order to insulate parties from unseen financial obligations and risks. Recognized opportunities, obstacles and risks and take reimbursement actions required to protect the company’s existing and future business. Provided support to the Billings, Collections and Clinical departments in a fast-paced environment.

Required Testing:

***Important: As part of this resume packet, please ensure to include test scores along with all assessment details, including charts. Candidates presented without this detail cannot be considered. Thank you

Excel 2007/2010 - http://www.skills-assessment.net/home/frmIndex.aspx?e=1

Word 2007 - http://www.skills-assessment.net/home/frmIndex.aspx?e=16

Microsoft Word Test Score (Basic)

Microsoft Excel Test Score (Basic)

Reimbursement Experience (# of years)

Degree Received

College/University

Currently Attending College/University (Y/N)

BBA

University of the District Columbia

No

Experience: (Paste Job Seeker resume below)

MARGARET N. ANYANSO

4909 EDGEWARE TERRACE

FREDERICK, MD 21703

240-***-****

ac4pbu@r.postjobfree.com

Summary: Billing Specialist with over 10 years of experience in medical and dental claims processing, Medicare/Medicaid billing, and retail customer service experience.

Employment:

October 2010-Present

Part Time Retail Sales Associate

Frederick, Maryland

Retail specialist at Macy’s, JC Penny and Lord & Taylor.

Assist customers in locating items for purchase.

Provide information to customers on store merchandise.

Operate sales register and reconcile cash.

January 2007-October 2010

Reimbursement Case Manager

TheraCom/Caremark Inc.

Rockville, Maryland

Provided information necessary for patient's financial planning.

Responsible for case assignments for ongoing, life sustaining therapies.

Reimbursement verifications and research to investigate insurance claims in order to insulate parties from unforeseen financial obligations and risks.

Recognized opportunities, obstacles and risks and take reimbursement actions required to protect the company's existing and future business.

Provided support to the Billings, Collections and Clinical departments in a fast-paced environment.

Authorization and rate negotiations to assure payment for products and services rendered.

Applied extensive knowledge of public and private insurance & contracting policies and practices.

Used ICD-9, CPT-4 Codes and Modifiers when applicable for swift resolution of claim issues and payments.

April 2006 – December 2006

S.E. Region Medicaid Billing Specialist

Maxim Health Services, Columbia, Maryland

Responsible for analysis, quality control, calculations and reimbursement payments of $8M to hospitals, nursing homes, ambulatory surgery centers and patients.

Calculated revenues and kept statistical data required to reimburse clients daily.

Audited Credit Reports weekly to identify over-payments/underpayments and reconciled outstanding balances.

Used knowledge of Medicaid, COB, COBRA and other federally mandated policies and procedures to process and pay insurance benefits to customers.

Prepared and submitted appeals to insurance carriers of Medicare/Medicaid within time specified according to terms, conditions and provisions established to secure payment.

Corresponded often with health care providers, healthcare professionals, and insurance carriers to resolve claim issues.

June 2003-September 2004

Medicare Billing Specialist

Sunrise Senior Assisted Living, Mclean, VA

Managed accounts of $125M for nursing homes that housed live-in Sunrise residents.

Analysis, quality control, calculations and payments of claim benefits.

Used Microsoft Access database, Excel Spreadsheets and statistical reports to track under-payments and over-payments.

Audited Credit Reports quarterly.

Used knowledge of Medicare, COB, COBRA and other federally mandated policies and procedures to process and pay insurance benefits to customers; hospitals, nursing homes, and ambulatory surgery centers.

Used CPT-4 coders/Modifiers, ICD-9 codes, HCPCS codes when applicable for the resolution of claim payments.

Prepared and submitted appeals on claims to insurance health carriers, Medicare/Medicaid within period specified according to terms & conditions, and provisions required to secure payment.

Written and verbal communications with healthcare providers, professionals, health insurance companies, Medicare/Medicaid officials for the resolution of claim issues and payments.

March 1996-Setember 2002

Claims Benefit Specialist

Aetna US HealthCare, Largo, Maryland

Processed HMO, non-hospital medical and dental claims using on line multi-processing system in a fast-paced production environment.

Provided analysis and quality control calculations of claim benefits payments to customers, hospitals, nursing homes, ambulatory surgery centers.

Reviewed, researched and audited claims processed by junior processors.

Calculated revenue and statistical data required to reimburse clients on a daily basis.

Applied knowledge of Medicare/Medicaid, COB, COBRA, ICD-9 & CPT-codes/modifiers when applicable to resolve claim issues and payments to achieve the correct adjudication.

January 1993-January 1996

Claims Examiner/Processor

Group Insurance Administration, Washington, DC

Processed medical and dental insurance claims.

Cash reconciliation, fund accounting on a CRT multi-processing system using ICD-9 codes, CPT-4 codes/modifiers where necessary for correct adjudication in a production driven environment.

Resolved claims, enrollment and eligibility issues relating to hospitals, nursing homes, ambulatory surgery centers, and patients.

June 1990-September 1991

Claims Processor

Protocol Inc., Vienna, VA

Processed HMO, non-hospital medical and dental claims using on line multi-processing system in a fast-paced production environment.

Analysis and quality control. Calculations of claim benefits payments to customers.

Researched, audited and calculated revenue and statistical data required to reimburse clients on a daily basis.

Used knowledge of Medicare, COB, COBRA and other federally mandated policies and procedures to process and pay insurance claims.

Used ICD-9 codes, CPT-4 codes, Revenue codes, surgery and Maternity codes when required to perform correct adjudication of claim payments.

January 1985-September 1989

Claims Examiner

Claims Administration Corporation, Rockville, Maryland

Processed medical and dental claims on a CRT-terminal using ICD-9 codes, SPT-4/modifiers codes in a production driven environment.

Researched claims underpaid, overpaid and made necessary adjusting entries and calculations.

Corresponded with hospitals, doctors and patients on issues regarding eligibility status and used federally mandated policies & procedures to resolve claims and payment issues.

Education

University of the District of Columbia, Washington DC

B.B.A, Accounting

University of Maryland

Coursework towards MBA and MS in Hospital Administration

Frederick Community College

Coursework towards B.S. Nursing

Skills: Microsoft Office, Insurance Access Systems, CRT Insurance System, Retail cash register.

Patient Access Specialist Pre-Screening Questions

Important: Please provide as much relevant detail as possible; including examples of duties performed, project/tasks completed and steps taken to accomplish.

Provided authorization and rate negotiations to assure payment for product and services rendered. Applied extensive knowledge of public and private insurance and contracting policies and practice. Used ICD-9, CPT-4 codes and Modifiers when applicable for swift resolution of claim issues and payments. Reimbursement verifications and research to investigate insurance claims in order to insulate parties from unforeseen financial obligations and risks.

The Patient Access Specialist role provides support across 3 regions; therefore scheduling may vary. Are you able to work until 8pm EST? Yes

Do you have any scheduled vacation and/or time off in the next 90 days? If so, when?

NO



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