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Medical Air Force

Location:
Hollywood, FL
Posted:
June 22, 2018

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Resume:

Licensed *-** Claims Adjuster

Currently seeking a new career opportunity. Have worked for more than 15 years in the workers’ compensation arena. Now looking for a change in profession. Extensive outside contact with employers, medical providers, injured workers, and vendors; provided excellent service in resolving problems via incoming calls and emails. Prior position served as a liaison between the injured worker, adjuster and medical provider. Point of contact for after-hours reporting of catastrophic injuries. Maintained daily, weekly and monthly assignment data for presentation to company’s vice president.

Summary of Professional Skills:

•Microsoft Office

•Team Player

•Flexible

•Prompt

•Organized

•Collaborator

•Integrity

•Action Oriented

Experience

Patriot Care Management- Fort Lauderdale, FL 01/2007 – 01/2018

Triage Case Manager / Coordinator:

•Reviewed newly imported files for telephonic case management (TCM) assignment and /or closure.

•Streamlined assignment process expanding the number of files assigned daily; greatly increasing monthly revenue.

•Thoroughly investigated monthly billing disputes; located $17,000.00 not received for TCM Services rendered.

•Decreased the amount of refunds requested.

•Created data spreadsheet identifying files assigned; closed; monitored.

•Reported potential personnel shortage to Vice President.

•Communicated daily with client (adjuster) request on TCM assignment.

•Facilitated communication between TCM Supervisor and adjuster on older closed files.

•Arranged with outside vendor for field on-site request.

•Monitored daily each TCM's current cases; Balanced work-loads.

•Weekly regional reports identifying current open caseloads for each region.

•Reviewed files for TCM billing disputes and reported outcome to the company's president.

•Co-authored training manual for triage department.

•Worked alongside VP in implementing new software for TCM Department.

•Provided data to CFO for separate TCM billing due to outside vendor referral.

•Maintained quality data for issues related to outside vendor referrals.

•Suggested and led portions of trial opening program team during staff shortage. Boosting team morale.

•Maintained assignment history for presentation to CEO when requested.

Aequicap Claims, Services f/k/a Claims Control, Inc – Ft. Lauderdale, FL 01/2005 to 01/ 2007

Workers' Compensation Case Manager

• Served as a Liaison between the employee, adjuster and provider.

• Authorized all work related medical treatment including surgery, diagnostic testing and medication.

• Monitored for compliance with medical treatment and return to work status.

• Addressed major contributing cause with medical provider.

• Coordinated peer reviews.

• Scheduled second opinions with option to treat.

• Arranged one-time change in providers including: follow up with written communication with the injured worker, former provider, and new provider.

• Assisted with appointment for employer/carriers Independent Medical Examination (IME) as well as injured worker's IME.

• Reviewed files for over-utilization along with coordinate utilization review.

• Communicated with physician and pharmacist, re: medication management.

Education:

Miami Dade Community College -Miami Gardens, FL 01/2008 – 01/2008

Curriculum: Accredited Claims Adjuster's

Capps College -Mobile, AL 01/1993 - 10/1993

Curriculum: Medical Assistant

Sheppard Air Force Base, TX 08/1985 - 10/1985

Curriculum: Financial Service Specialist

Lackland Air Force Base, TX 07/1985 - 08/1985

Curriculum: Basic Training

Lillie B. Williamson High School -Mobile, AL 08/1981 - 06/1985

Curriculum: General Education – High School Diploma



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