YOLANDA HOLLENQUEST

Alpharetta, GA.

actntj@r.postjobfree.com

Cell 678-***-****

OBJECTIVE: Position as a Licensed Workers Compensation Adjuster in the State of Georgia

QUALIFICATIONS

** ***** ** experience in Workers' Compensation Administration

Direct customer and third party experience

Excellent verbal, written and interpersonal communication skills

Excellent analytic, quantitative and deductive reasoning

Understanding of insurance claims handling procedures.

PROFESSIONAL EXPERIENCE

Wright Rehabilitation Services Woodstock, GA

2008 – Present

Workers Compensation Claims Assistant

Provide multi-state telephone, clerical and data entry support for the WRS Case Management Team. Supports Case Management for all non-clinical functions. Facilitates coordination of medical services to ensure the delivery of high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes.

Communicates and documents accurate clinical and financial information in both verbal and written forms in order to assist Case Managers in appropriate assessment, planning, implementation and evaluation of the patients continuing care needs.

Interprets and communicates payer requirements to Case manager, insurance companies, patient and physician.

Supports the case management outcome model through non-clinical, clerical and support services in order to assist with the planning, assessment and implementation of appropriate patient transitions.

Responsible for initial review and triage of Case Management tasks.

Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan.

Promotes communication, both internally and externally to enhance effectiveness of case management services (e.g., health care providers and health care team members, insurance Companies, TPA’s and Self-Insures).

Provides support services to case management team members by answering telephone calls, taking messages and researching information.

Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

Protects the confidentiality of client information and adheres to company policies regarding confidentiality.

May assist in the research and resolution of claims payment issues.

AIM Disability Management and Consulting Sandy Springs, GA

2005 – 2008

Office Manager (Workers Compensation)

Responsible for establishing and maintaining employee files, policies and procedures, and payroll, as well as Building and maintaining relationships with clients (insurance companies,

Self- Administrators and TPA’s)

Promptly answered all incoming calls and assist callers with proper telephone etiquette; must sound professional, credible, pleasant and sincere

Professional interaction with Physicians, Nurses, Insurance Adjusters and other medical professionals; Return of inquires within 24 hour

In-take/Data Entry of Case Management referrals into company software

•Improved quality by maintaining accurate consolidated reports on Adjuster's claims activity.

•Effectively managed tasks and time to adjust to deadlines that are inherent to claims activities.

•Utilized evolving computer technologies in a fast-paced environment.

•Enhanced and supported the work associated with the management of a Claims District.

•Processed sensitive information while maintaining a high level of confidentiality and integrity.

•Communicated claim activity and processing with the claimant and the client

•Ensured claim files are properly documented and claims coding is correct.

•Referred cases as appropriate to supervisor and management.

•Prepared reports on claims and loss statistics and other information as required.

•Kept effective diary management system to ensure that all claims are handled timely.

•Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority.

•Maintained claim files, have an effective diary system, and document claim file activities in accordance with established procedures.

•Updated appropriate parties as needed, providing new facts as they become available. Recognizes cases based on severity protocols to be referred timely to next level claims professional

•Apropriately dealt with information that is considered personal and confidential.

•Responsible for scanning, uploading and labeling of case documents into the appropriate case files.

Bridgeway Medical Montgomery, AL

2001 – 2005

Support Services Supervisor/Case Management

Communicate with clients, third party, and client holders

Prepare transcripts and input claims into electric system

Liaison to customers regarding questions and status claims

Setup initial claims and keep records of paperwork

Handle Medical Only claim files

Documents file activity on computer

Handle telephone calls for as needed

Complete referrals

Work collaboratively with Claims Examiners, Nurse Case Managers and other Assistant Claims Examiners

Contact with clients, injured workers, attorneys, doctors, vendors and other parties

Handled, managed and maintained a case load of assigned claims on an individual basis

Created and processed all invoices for submittal

Corvel Corporation Montgomery, AL

1996 – 2001

Administrative Assistant/Biller

Arranged facilities for meetings, performed administrative functions for other departments, reviewed and disseminated information received from other departments, and coordinated special projects. While working with the company I also handled all billing for the District, which included submitting invoices for payment

Licenses

Licensed Workers Compensation Adjuster in the State of Georgia

EDUCATION

Accounting Business Administration

Strayer University – Roswell, GA Bauder College, Atlanta, GA

2012 2008

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