Ina GelfoundIndustry Experience

Insurance

Health Care

Managed Care

Functional Experience

Project Management

Billing Specialist

Benefits Coordinator

Workers Comp

Denial Specialist

Audit

Collections / Appeals

Medicare / MediCal

Systems Experience

EDI Billing

HCS Registration

AS-400

MS Office

Education

William Paterson University

BA

San Diego

619-***-****

Relevant Business Experience Summary as Director and/or Non-Management Employee:

Consulting Project Engagements

VP Projects DivineCare Management Home Care

Customer Service Process Improvements, Delinquent Accounts, Receivable Resolution, Accurate Registration

and Intake History, Provider Network Credentialing and Recruitment

Genoptix Laboratories Interim Revenue Cycle Manager/Director

Implemented process improvements - hired and trained 4 additional Billers

Substantially reduced, number of days outstanding unbilled claims.

At star date, 49% of total claims were unbilled for 11+ days. Within six weeks of

implementing process improvements, billed 90% of all claims within 10 days of service.

Increased daily billing volume from $1 million to $1.3 million

Historic one day billing volume = $12.6 mil. 96% collected before year end

Corporate Director Department of Managed Care Meridian Health

Supervised 70 plus people in patient financial services for NJ health system.

Developed medical billing procedures to capture all service charges and coding for timely

billing accurate

reimbursement for acute care hospitals (inpatient and outpatient), free standing outpatient

facilities, faculty and staff

physicians, imaging, physical therapy laboratory and allied health services

Managed Care Contract Negotiator and Administrator All 50 Contracts Profitable

Process Improvement and Project Manager

Medical Billing Specialist for acute care hospitals, inpatient skilled nursing and outpatient

imaging, physical therapy, pharmacy and laboratory services

Co-ordination of benefits (COB) Denial and Appeals expert.- Implemented processes

improvements for insurance verification to identify payers to be billed as primary,

secondary or tertiary and to determine patient financial liabilities. Resulted in bringing

accounts receivables to 2% of billed charges

Claim Denial Specialist for government, commercial and workers compensation.

Developed Zero Denial Program with commercial health insurance companies i.e. Blue

Cross/Blue Shield (NJ) & Aetna

Team Associate- Appeals Specialist for all medical payers including TPAs, ERISA plans,

commercial, government payers, workers compensation payers and patient pay claims

Worked with IT team to produce HIPPA compliant profiles and reimbursement models for

UB-04 and HCFA 1500 billing to coordinate with payer reimbursement systems.

Team Associate - Collections Specialist for all payers and contract negotiator and

administrator for all managed care and direct services contracts.

Relevant Career Experience Timeline

INA - Insurance Negotiations and Assistance

2004 To The Independent Contractor (Formerly called AAA Revenue

Present Cycle Management Business currently operated by

family)Consultant Customer Service, Project Management

Netwk Develop/Credentialing Resolution of aged

receivables and denied claims

Resources Global Professionals

Consultant ( See Genoptix detail above)

Corp. Director Insurance and Medical billing (Co. sold)

2011 Advanced BioHealing Call Center Eligibility Specialist (Co

Sold)

2008 - 2010 Front Porch/Carlsbad by the Sea, Carlsbad, CA

Medical Billing Specialist/Manager

2007 IRM Integrated Revenue Management

Director of Client Services

1992 - 2004 Meridian Health

Corporate Director, Department of Managed Care

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