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ClaimExaminer/ ICD 9/ 10, HCPS/ medical coiding HIPPA OSHA Worker's

Location:
Merchantville, New Jersey, United States
Salary:
negotiable
Posted:
November 19, 2018

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Resume:

Linda Harvey Williams

**** **** *** • Pennsauken, NJ 08109• Cell 609-***-****) Home: 856-***-****• ac7qnf@r.postjobfree.com

PROFESSIONAL SUMMARY

Focused Workman’s Compensation/ TPL Subrogation insurance professional with 10+ years of claims handling experience. Advanced knowledge of coverage, medical, liability and complex claims handling procedures. Knowledgeable of state and federal laws with extensive expertise with the Centers for Medicare & Medicaid Services. Strong technical writing along with exceptional oral communications skills. Good interpersonal, analytical and negotiation skills. Medical coding and billing/ ICD-9/10; HCPCS and CPT experience.

EDUCATION

University of Notre Dame – Mendoza College of Business Notre Dame, IN

Certificate, Grant Writing: GPA 3.5

EXPERIENCE

Horizon Blue Cross Mount Laurel, NJ

September 2007 -April 2018

Third Party Liability Specialist

Process Auditor Claims Pend Specialist

•Managed and processed high dollar claims with payouts over $50,000.00

•Identified and led recovery of over $330K in overpayments

•Trained team of 10 in the use of the NASCO operating system

•Handled severe complex injury files and coverage issues.

•Works effectively with subrogation team and makes proper recommendations for disposition of

No-Fault and Workman’s Compensation claims

•Supports SIU involvement

•Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with plan contract provisions and all other governing policies and procedures

•Research and resolve Accounts Receivable (AR) issues to include the disposition of cash receipts in Universal Payment System (UPS).

•Exceptional knowledge of OSHA; ERISA; Medicare and Medicaid; COBRA; ESRD and state

and federal guidelines

•Advised team members, managers and directors on claim processing procedures

•Experience analyzing medical evidence, benefit and/or legal evidence to identify and recognize required actions for claim development.

•Advanced knowledge of Microsoft products; including SAS and pivot tables

•COB, Medicare and adjusted claims processing

•Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.

•Prepares necessary state fillings within statutory limits.

•Manages the litigation process; ensures timely and cost-effective claims resolution.

•Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to recover the cost of claims for the company

•HEDIS; SAP; SAS; Navinet; Careplanner; Burgess; NASCO

•ICD9/10 CPT and HCPC and CPT codes

Rising Star Caterers Cherry Hill, NJ

1994– 2007

Event Manager

•Responsible for business development and generating new accounts • Developed and trained

staff.

•Ensured adherence to company protocols

•Managed event logistics

•Reviewed and updated reports

•Supervised preparation of event guides and third-party delegates materials

Tom Ridge for Governor Philadelphia, PA 1992 - 1994

Minority Coalition Manager

•Trained and develop over 150 volunteers and 20 staff members during the campaign

•Negotiated contracts.

•Created targeted advertisements and made media buys

•Maintained office payroll, petty cash, schedules and training manuals

COMMUNITY SERVICE/ ADDITIONAL SKILLS

•Ordained and licensed Minister

•Peer mediation 50-hour Stephen’s Ministry training to provide counsel and peer to peer support to individuals dealing with tragic life events

•Life Application Seminar: provide Bible based life skills training to inmates incarcerated with the NJ Department of Corrections

•Grant writing seminars: provide free grant writing classes and support to non-profits



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