Insurance Manager
Resume:
New Rochelle, NY *****
************@*******.***
ALISHA OCASIO
OBJECTIVE
Seeking a challenging and rewarding career in a diverse environment where my strong work ethic, vast knowledge and expertise can be used to help promote the mission of the organization and exceed team goals.
SKILLS & ABILITIES
Bilingual Spanish/English, fluent in all Microsoft Office applications, knowledgeable of all ICD-10 coding, CPT & HCPS coding. computer literate and an extremely fast learner.
EXPERIENCE
DIRECTOR OF REVENUE MANAGEMENT AND OPERATIONS, ADVANCED MEDICINE ASSOCIATES
2012-Present
Responsible for all credentialing and for physicians in a busy Oncology and Internal Medicine Practice and hiring and termination of employees for two locations.
Maintain current medication pricings for oncology drugs, vaccines, etc to ensure proper insurance reimbursement.
Ensure all staff is working to optimized potential and is trained appropriately for duties.
Reconcile weekly deposits to income generated by insurance companies.
Appeal and dispute denied claims with insurance carries and refer specific cases to NYSIF and the NYS Attorney General’s office for further investigation when necessary.
Procure financial assistance for patients in need of help from either private grants or drug manufacturers in order to provide the medically required treatments.
Update all software applications including EMR to ensure compliance with all applicable regulations as well as all in office technology including servers.
Analyze and negotiate all prospective insurance contracts and vendor contracts for medications.
Implemented operations to ensure the collection of Meaningful Use measures in order to qualify for incentive payments with CMS
MEDICAL BILLING SPECIALIST, PATIENT CARE ASSOCIATES
2008-2012
Was responsible for all Medicaid operations including posting, transmitting of claims, and eligibility.
Trained and educated new and existing staff on NYS EPACES usage.
Negotiated and oversaw Medicaid audits internally as well as being the direct liaison to the Department of Health to ensure all state regulations and policies were being met.
Submitted claims to all insurance carriers for payment and ensured they recognized portable x-ray specific coding as per CMS policy including WC, No Fault, Medicare, and HMOs.
Composed letters for the entire billing department to utilize as templates for itemized bills to patients as well as appeal letters for insurance company denials.
MEDICAID BILLING MANAGER/CONSULTANT, R&P MEDICAL INC.
1999-2013
Was responsible for all electronic billing transactions ensuring accuracy in all ICD-9/CPT coding for all Medicaid and Commercials insurances.
Acted as the direct liaison to New York State Medicaid and the Department of Health and HMOs.
Updated and maintained all new versions of Fastrack Software while also responding to any and all inquiries pertaining to software and networking issues.
Conducted annual internal audits, maintained a 0% error rate in State conducted audits
Practice Manager and Coordinator/Consultant, Dr. Raja Ogirala, MD
2004-Present (Per Diem)
Created an effective billing unit for the office.
Responsible to hire and train all office employees.
Maintain a steady revenue cycle via electronic billing submissions and analyze those payments to ensure that office operations including supplies, payroll and business taxes are met timely and effectively.
Act as direct liaison to Medicare and New York State Medicaid all other insurance companies.
Negotiated partnerships with other entities to promote and enhance revenue from Sleep Lab business.
Analyzed all insurance and business contracts prior to execution by the physician.
EDUCATION
COPPIN STATE UNIVERSITY – BALTIMORE, MD
Dual Major: Computer Science and Media Arts
Accumulated 110 credits with a 3.6 GPA and a member of the Honors Program and recipient of the Thurgood Marshall Scholarship for Academic Excellence
COMMUNICATION
Researched and negotiated a settlement with Oxford insurance company for over $100K as a result of improper claims’ processing by the insurer for many years prior to even being with the company that had been written off as a loss by prior billers. Worked directly with the Department of Health and CSC to implement system changes to the state billing system for all NYS Portable X-Ray suppliers.
REFERENCES
AVAILABLE UPON REQUEST
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