Customer Service Medical
Resume:
LAURIE LAMANNA
Apt. ***
McKinney, TX 75072
*****************@*****.***
EDUCATION
Bachelor in Business Administration with a concentration in Management; Kaplan University; 2011; GPA 3.8
CERTIFICATIONS
CRCR Certified; 2016
Lean Certified; 2012
HIPPA compliance; 2004
Medical Terminology; 2002
Coding; 2001
TECHNICAL SKILLS
Microsoft Word, Excel, PowerPoint, Access, Outlook, SharePoint, Visio, SQL, Macro, and Medical Management Systems including EDS, EDI, NASCO, McKesson, Medical Manager, Antrim, Atlis, IDX - Flowcast system 3.0 and 4.0, Oracle, Apex, EHR, and Smart devices
EXPERIENCE
Quality Federal Analyst / Account Resolution Specialist / Insurance Administrator III, Durable Medical Equipment Orthofix, Lewisville, Texas May 2010 to Present
Plans, coordinates, and implements the quality improvements for Third Party BioStim. Make recommendation to management to ensure quality revenue recognition process stay current and accurate.
-Demonstrated problem solving, implement and provide resolution to quality processes.
-Assist in the development of quality control standards – Standard Operational Procedures.
-Create work instructions to execute quality improvement for Insurance Administrators.
-Work as liaison with Accounts Receivable to ensure open communication between both departments. Ensure payer trend changes and denials are recognized and communicated in a timely manner.
-Make recommendations on front end revenue decisions based on documented outcomes.
-Be able to analyze and interpret revenue transactions including booking revenue, reversal and write off’s, etc.
-Provide monthly meeting with management team to go over the quality trends within the department.
-Interpret patient clinical condition utilizing physician patient records, then comparing to specific payer guidelines determine financial responsibility and effectively communicate to customers/payers.
-Timely completion of all corporate wide and departmental training.
-Perform final analyst of order prior to release; review for accuracy and content.
-In depth knowledge of insurance companies and associated contract types.
-Knowledge of anatomy, products and related clinical studies.
-Understand and promote Compliance adherence.
-Other projects as assigned.
Collector II (Accounts Receivable), Pharmaceutical March 2009 to April 2010
Amerisource Bergen, Frisco, Texas
Reviewed complex government, no-fault, worker’s compensation, commercial / national contracted plans and high dollar insurance claims. Effectively assigned NDC codes to facilitate billing as per intricate carrier contracts for pharmaceuticals. Created and updated Aging Reports in Microsoft Excel for use in generating statements.
-Reviewed reimbursement and overpayments for customer and insurance carriers. Calculated refunds.
-Reduced the number of aged accounts to less than 60 days old.
-Began as a temporary employee and hired full time upon completion of initial assignment.
Billing Analyst, Laboratory April 2006 to February 2009
Ameripath, Addison, Texas
Gathered business requirements to support operational process improvement initiatives. Submitted detailed reports outlining interpretation of financial impact of implemented initiatives in collaboration with the Managed Care Department to determine Expect Pricing for the Flowcast system. Generated weekly status reports in Excel. Electronically submitted claims to clearinghouse (EDI - Emdeon). Identified and resolved electronic claim discrepancies within system edit reports.
-Provided manual user acceptance testing of billing system using invoice source documents. Outlined and verified claim output. Performed manual retesting following developer customizations. Created developer instructions in spreadsheet format for reference material.
-Successfully directed Accounts Receivable Recovery Project with DSO over 90 - 180 days old.
-Facilitated cash collections with consistent and comprehensive follow-up activities for customers and health insurance carriers for outstanding debt.
-Created PowerPoint presentations for use in HIPPA Compliance and Customer Service training for the Corporate Training Department.
-Certified the effectiveness of internal controls, as per Sarbanes-Oxley standards, including a workflow control process combined with an image archival system that effectively controlled billing, accounts payable and accounting outsourcing activities.
Accounts Receivable Analyst, Hospital Inpatient/Outpatient Services November 2004 to April 2006
MD-X Solutions, Mahwah, New Jersey
Effectively employed revenue cycle technology for hospitals based on inpatient and outpatient services. Trained and supervised new hires on billing and collections functions and processing Federal, Contracted Plans, No-Fault, Commercial, and Worker’s Comp claims.
-Calculated DRG’s /Per Diem for inpatient admissions.
-Completed requirements for HIPPA certification.
Senior Claims Analyst, Laboratory/Family Practice/Internal Medicine April 2003 to November 2004
University of Texas Southwestern Medical Center/Health System, Dallas, Texas
Negotiated DSO average to less than 60 days. Investigated, evaluated, and settled claims, applying technical knowledge and ethical skills for fair and prompt disposal of accounts.
-Instrumental in reduced loss ratio with effective resolution of complex, severe exposure claims with high service oriented claims handling.
Contact this candidate