Reimbursement Counselor

CONNIE THOMAS

512-***-**** ************@*****.***

SUMMARY OF QUALIFICATIONS

• Administrative & Clinical Experience with Healthcare, Legal, Insurance, Benefits and Eligibility

• Professional, Dependable, Accountable, Self Starter

• Employee of the Month-Hospital Patient Services; Winner: 1 st Place Most Cases Closed- McKesson

EDUCATION

TechSkills, Healthcare Systems Information Specialist Program, CMAA, CBS

Almeda University, B.S., Public Administration

Southern Careers Institute, Paralegal Certification

PROFESSIONAL EXPERIENCE

Reimbursement Counselor, McKesson Specialty Health Pharmaceutical and Biotech Solutions 12/13-

• Tecfidera ™ Benefit Investigations with Reimbursement Counseling to Physicians

• Extensive and Customized Analyses of Alternate Funding Opportunities for Tecfidera ™`

• Appeals and Prior Authorization Support and Guidance, Monitor Adverse Events

• Reported on Utilization Trends, Payer Trends and Benefit Investigations

Medical Billing Specialist, Rural Metro/Southwest Ambulance 03/2012- 12/2013

• Verified documentation by crews for medical transport billing for the WA, OR, and CA regions

• Verified insurance coverage and payer information to invoice and code patient transports

• Contacted insurance companies, hospitals, prisons, state offices to obtain information and eligibility

• Used Lexis, Insurance, and Vendor websites to correct patient demographics, insurance and billing

records between RM’s ambulances system and Rural Metro’s Billing system

Campus Support Coordinator, TechSkills, LLC 09/2011-12/2011

• Testing Administrator for PearsonVue and Prometric Certification Exams for IT and Med Assts

• Representative to AZ employers, DES, and VA for certification of students’ academic/time hours

• Ordered instructional supplies, books, testing vouchers and campus miscellaneous needs

• Responsible for confidentiality of student records and adherence to strict confidentiality procedures

Document Production Clerk, US Census Bureau 02/2010-05/2010

• Reported to Dept. of Commerce in the largest mobilization of US workers during peacetime

• Prepared Census 2010 forms for imaging by labeling, smoothing, and separating into batches and

trays for the Document Imaging Unit

• Surpassed all established productivity and accuracy standards and goals set by Team Leaders,

received weekly productivity bonuses

Inpatient Case Manager, Hospital Patient Services, Inc. 07/2008-08/2009

• Interviewed Inpatients without medical insurance for AHCCCS. Functioned as a Patient Advocate

between the patient and the Department of Economic Security until the PT received benefits and

hospital was reimbursed

• Coordinated billing records between AHCCCS, Hospital Patient Services and Banner Baywood,

Banner Heart, Banner Desert and Gilbert Hospitals for all patients and contracted services providers.

• Reduced un-reimbursed charges to Hospitals, Medical Providers, and Agencies

Customer Care Representative, CVS/Caremark 08/2007-07/2008

• Resolution Specialist for the Federal Employee Prescription Drug Program

• Fast Paced environment used multiple computer systems to troubleshoot claims and benefits

• Solved benefit and claim issues for Pharmacies and Federal Employee Plan Members

• Educated members on benefits, prior authorizations and policy issues, and plan selections

CONNIE THOMAS

512-***-**** ************@*****.***

Hearings and Appeals Specialist, First Data Government Solutions, LLC 05/2006-01/2007

• Researched and documented client complaints and requests for Administrative Hearings appealing

food stamp, Medicaid, and cash assistance program denials for the State of Texas

• Assembled all case materials required by Health and Human Services Policies for Hearing Officers

• Exceeded established productivity, accuracy, and timeliness standards completing appeal requests

Texas Works Advisor, Texas Health and Human Services 01/2003-04/2006

• Determined eligibility for Texas Food Stamp, Medicaid, and TANF cash assistance programs

• Researched client issues and problem cases and determined benefit corrections

• Interviewed clients and assisted with obtaining verification documents to obtain benefits

• Monitored client compliance with work or study programs required to retain eligibility

• Experience with Simplified Nutrition Assistance Program, FEMA, & TX Disaster Assistance Programs

Paralegal, Broadwing Communications Services, Inc. 11/1996-01/2001

• Drafted legal filings, coordinated Discovery and Production, and Subpoena Compliance

• Managed Broadwing’s due diligence data room for Cincinnati Bell’s Merger

• Assisted with Mediation and Arbitration, witness preparation, depositions

• Managed time for six Broadwing attorneys, liaison for Broadwing’s outside counsel in litigation

Clinical Systems Analyst, Seton Medical Center, Austin Texas 10/1990-01/1995

• Using Shared Medical Systems software, created lab test ordering, billing, and statistical paths

• Organized the clinical laboratory requests for screen changes hospital wide

• QA’d the interfaces between Pathlab3 and Shared Medical, hospital billing, & medical records

Laboratory Data Center Manager, Seton Medical Center, Austin, Texas

• Assisted with installation and database building of Pathlab3, Clinical Laboratory Info System

• Developed backup and troubleshooting procedures for Night Shift Maintenance personnel

• Coordinated and built, trained and tested the clinical software databases for Hematology, Chemistry,

Pathology, and Toxicology departments

Lab Tech III-Phlebotomy Supervisor, Seton Medical Center, Austin Texas 10/1980-

• Staffed and coordinated 15-20 night shift phlebotomists for the “Morning Run”, coordinated

venipunctures, heelsticks, and arterial punctures with the appropriate clinical staff

• Primary contact for hospital unit clerks, nurses, and physicians for test ordering questions and or

clinical testing procedures

• Verified identification of patient specimens and tests ordered, triaged specimens to correct clinical

testing areas

Professional Associations

2

Veterans of Foreign Wars of the United States, Life Member Ladies Auxiliary # 200147328

Post # 3513 Scottsdale, AZ

Thunder Mountain VFW Motorcycle Riders Member, Phoenix 100 Club Member

3

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