Customer Service Management
Resume:
ANTHONY J. BOSTWICK
Oakland Park, FL. 33309
*************@*******.***
SUMMARY A management professional offering over twenty years experience in Claims and over ten
in the management of staff to ensure establishment of productive and reliable teams to
achieve goals. Recognized for reducing claims inventory from 14 to 4 business days.
Instituted a program to focus processing that resulted in increased production and quality.
Have a positive and friendly attitude, demonstration of initiative and with ability to manage
multiple tasks. Highly organized and have excellent time management skills. Solid fraud
identification and skilled at computer software including Microsoft Office and claim
processing systems (IDX, PowerMHS, Qcare, Amisys, GMS and Great Plains.
PROFILE
• Excellent customer service skills
• Adapt easily to new concepts and responsibilities
• Attentive to details, dedicated and goal-oriented
• Quick to learn new programs and procedures
EXPERIENCE
7/11 – 12/14 Claims Manager (7/11 – 12/14) Delray Beach, FL
American Eldercare, Inc.
• Monitored daily reports of production, accuracy and timely payments to Senior
Management
• Monitored inventory from date received to date of payment
• Processed checks for providers through Accounting Great Plains system
• Distributed assignments throughout the department in accordance of priority
• Process payroll through ADP/E-time system
• Hire, train, promote and terminate employees as necessary
Supervisor, Service Operations (9/06-7/11)
Coventry Health Care (acquired Vista Health) Sunrise, FL
• Promoted to this position from Senior Financial Auditor
• Led team of 15 Claims Examiners and Customer Service Representatives
• Audited and tested new contracts for payment accuracy and configuration
• Met weekly with Chief Financial Officer to review high dollar facility claims
• Extensive experience with provider contract and benefit interpretation
• Provider coding and root cause analysis with process improvement
• Key in conversion of MHS to IDX (Data Bases) as it affects Claims and Recoveries
SR. Operational & Financial Recovery Auditor (2/01-9/06)
Vista Health Plan Sunrise, FL
• Reconciliation of large facility accounts for high dollar overpayments for a
department that averaged over $2.5 million in recoveries monthly
• Developed trends and designed reports to identify and recover overpayments from
facilities and physicians (these reports can generate up to $8 million in identified
overpayments yearly with more than 80% collected)
• Issued resolution management within all departments at Vista to foster the overall
success of the company (approximately 85% of the reported issues never resulted in
additional overpayments)
Reconciliation and Overpayment Identification Auditor (2/00-2/01)
Vista Health Plan (acquired HIP Health Plans) Sunrise, FL
• Conducted random audits to verify correct contractual reimbursements
• Audited each function of various departments (Accounts Payable, Claims, and
Provider Contracting)
• Audited High Dollar Claims for identification of overpayments which included
contract interpretation, payment accuracy, benefit integrity, possible fraud
identification and adherence to state regulations
Supervisor Contract Administration (1/99-2/00)
HIP Health Plans of South Florida Hollywood, FL
• Supervised team of 11 Information Specialists, responsible for loading Physician,
Facility, and Group contracts
• Coached and developed new as well as existing employees on departmental and
company policies and procedures to assure a positive working environment
Auditor / Trainer (4/98–1/99)
HIP Health Plans of South Florida Hollywood, FL
• Performed detailed claim audits to monitor individual performance
• Provided feedback to management and complete auditing reports
• Conducted training for all newly hired Claims and Customer Service staff
EDUCATION
2015 Allied School
Currently enrolled Medical Coding program
Medical Coding
2006 Broward College Fort Lauderdale, FL
Business Administration
1987 – 1988 Mohawk Valley Community College Utica, NY
Banking/Insurance
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