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Licensed Health and Life Insurance Account Manager

Location:
Houston, TX
Salary:
60,000 annual
Posted:
March 13, 2019

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Resume:

Juan Perez

Houston, TX ***** • ac8rx0@r.postjobfree.com • Ph: 713-***-****

Laboratory Billing Manager

Manager of Business Services and Laboratory and Anatomical Pathology Billing Professional with over 10 years of experience and a bachelor’s degree in Business/ Healthcare Administration and a Texas

Insurance License in General Lines – Life, Accident, Health, HMO

Experienced with a variety of ordering client mix: independent laboratories, hospitals, independent clinics, independent physicians, dermatologists, pathologists, skilled nursing facilities, etc.

Experienced in resolving Laboratory and Anatomical Pathology client and patient billing issues.

Able to manage accurate and current Laboratory and Anatomical Pathology charge masters as well as third-party billing and compliance for Medicare, Medicaid, and Commercial health plans.

Excellent written and verbal communication bilingual with fluency in English and Spanish able to offer excellence in customer service and client retention.

History of training and developing employees of all levels on CPT, HCPCS, Billing Modifiers, HIPPA, ICD - 10, Stark, AKB, and False Claims Act.

Adept at front-end and back-end revenue cycle management.

Experienced and licensed Medicare and Commercial insurance advisor and sales.

Professional Experience

North American Senior Benefits, Houston, TX, 77090

License Insurance Agent/ Benefits Coordinator, 2/2019 to current (Part-Time)

Set appointments, perform face -to-face presentations, and needs assessments with qualified prospects in efforts to successfully market to and align them with quality Mortgage Protection, Final Expense, and Life Insurance products (Whole Life, Term Life, and Universal Life Insurance products).

Aon Hewitt, The Woodlands, TX, 77381/ Contemporary Staffing Solutions, Mt Laurel, NJ, 08054

Licensed Health Benefits Adviser, 9/ 2018 – 12/ 2018 (Medicare AEP)

Performed needs assessments and communicated Medicare health insurance coverage benefits and options to interested and qualified individuals. Enrolled qualified individuals into Medicare commercial insurance products through a national carrier.

National Agents Alliance, Houston, TX, 77090

License Insurance Agent/ Benefits Coordinator, 9/2018 to 2/2019 (Part-Time)

Set appointments, perform face -to-face presentations, and needs assessments with qualified prospects in efforts to successfully market to and align them with quality Mortgage Protection, Final Expense, and Life Insurance products (Whole Life, Term Life, and Universal Life Insurance products).

CHRISTUS Trinity Mother Frances Heath System, Tyler, TX, 75701

Manager of Business Services/ Laboratory Billing Manager, 1/ 2016 to 6/ 2018

Managed Laboratory and Anatomical Pathology billing and billing compliance for 108 medical facilities including hospitals, urgent care centers, an independent laboratory system. Oversaw 2016 CMS Protecting Access to Medicare (PAMA) act reporting project. Improved the quality of ordering client's submission of patient and medical documentation for billing accuracy and improved clean claim rate. Trained employees on billing compliance and regulations including Stark Law, Fair Market value and pricing, False Claims Act, HIPPA, and Anti-Kickback Statute.

Selected Contributions:

Decreased health system's medical necessity denials by 30% within 14 months of initial employment date by improving physician alignment with lab billing regulations and the health system's billing goals - improve clean claim rate, decrease denial rate, improve timely reimbursement, and reduce days in AR.

Adjusted and released over $26M of the health system's insurance claims held for billing issues within the first four months of initial employment date.

Managed held claims for Medicare, Medicaid, and Third-Party Commercial payers and made necessary billing adjustments for billing issues concerning NCCI edits, MUE edits, errant patient and medical documentation, medical necessity, and questionable charges – approximately 100 to 150 claims daily with average billings of 1M to 3M daily.

Managed the revenue cycle for CHRISTUS Trincare Independent Laboratories. Included 4 billers 500 to 600 lab requisitions/ claims daily with average billing of 1M to 1.2M per month.

Decreased the independent lab system's medical necessity and lack of authorization denials by approximately 25% each within 14 months of initial employment date by improving physician alignment with lab billing regulations and health system's billing goals - improve clean claim rate, decrease denial rate, improve timely reimbursement, and reduce days in AR from 55D to 35D.

Developed financial and utilization metrics for improved management of key performance indicators.

St Joseph Medical Center, Houston, TX, 77001

Laboratory Financial Coordinator, 8/ 2007 to 1/ 2016

Directed Laboratory and Anatomical Pathology billing, billing compliance, and customer service and lab registration departments, and all lab financial reporting. Oversaw all Medicare, Medicaid, Third-party Commercial, and Direct Contract Client account billing. Interviewed and trained new staff members. Collaborated with outreach ordering clients and hospital departments to develop more efficient and compliant Laboratory Anatomical Pathology revenue cycle processes.

Selected Contributions:

Decreased insurance denials due to coding, charge errors, and medical necessity issues netting approximately $10M - $12M yearly contribution margins for each of three hospitals labs by updating lab charge description masters and implementing new billing software.

Resolved daily ordering client's billing and billing compliance issues.

Decreased denials by approximately 90% within 12 months of initial employment date by improving the quality of ordering client's submission of patient and medical documentation, implementing new compliance program, polices, and guidelines.

Maintained direct contract client accounts with average monthly billings of $250K to $300K and a 95% collection rate within 60 days of monthly invoiced date.

Developed financial and utilization metrics for improved management of key performance indicators.

Laboratory Reimbursement Coordinator, CHRISTUS St. Joseph Hospital, Houston, Texas, 77001, 6/ 2000 to 8/ 2007

Managed Clinical Laboratory and Anatomical Pathology client service contracts. Decreased denials by 60% within 3 months. Reduced days in AR and improved clean claim rate.

Selected Contributions:

Laboratory Liaison team member involved in installing facility wide McKesson Pathway Compliance Information system. Management of Laboratory and Anatomical Pathology billing and billing compliance.

Management and maintenance of CARE-EVOLVE internet-based laboratory and physician electronic medical records (EMR) system.

Management of laboratory out-patient registrations for the facility’s Reference Laboratory and hospital out-patient laboratory departments.

Performed as Laboratory Safety and Security Officer and liaison to Hospital Safety Security teams from 2001 – 2003.

Developed financial and utilization metrics for improved management of key performance indicators.

Information Systems: McKesson STAR, Epic, Cerner Millennium, MISYS, Frontline Lab Inventory and Logistics, MedAssets, TELCOR, CARE-EVOLVE EMR, Microsoft Office Suite, Dashboard CRM, InConnect and Web Max Soft Telephone system, Dashboard CRM

Education

Bachelors, Business/ Healthcare Administration,

University of Houston, Victoria, TX

License:

General Lines – Life, Accident, Health, and HMO

Licensed in TX, NM, FL, ME, SC, TN, MN, MI, VA, MO, OH, SD

Certifications:

A.H.I.P., F.F.M, S.H.O.P. Silver Scripts PHARM Certification



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