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Medical Insurance

Location:
Winter Park, FL
Posted:
April 23, 2016

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Resume:

Moses Manning, Jr.

**** **** ***** ****, *******, FL 32807

386-***-**** (cell): 407-***-**** (work): Email: acuha5@r.postjobfree.com

Objective Statement:

I am a highly skilled, experienced leader and a highly motivated professional with an established record of outstanding accomplishment spanning more than thirty years. I have comprehensive expertise with demonstrated ability to lead cross-functional teams of diverse groups in a fast paced and matrix organization. I am recognized as a highly creative, results-oriented and solution focused individual.

My areas of strength include but not limited to:

Strategic thinker with strong business acumen and leadership skills

Exceptional Communication Skills

Works Independently or as a Team Player

Excellent Time Management Skills

Outstanding Organizational Skills

Very Strong Computer Knowledge

Thorough Trainer of Personnel

Experience and Employment History:

Nov 2009-Present: Department of Veterans Affairs, Orlando Veterans Healthcare Administration (VHA): Lead Medical Reimbursement Technician, 2500 Lakemont Ave, Orlando, FL 32803; 40 Hours, Full Time; Supervisor-Juan Carrion; 407-***-****.

Daily Duties Include:

Validates patients’ billing information, selecting and completing the insurance coverage information for the patient in their quest to access medical care

Duties include calling up private insurance companies where patients have accounts, Medicare, and Medicaid, to verify and obtain information concerning insurance benefits

Updates patients’ claims, re-verify patient’s current insurance, confirms if a patient’s insurance benefit plan takes into consideration all selected products needed by veteran affairs

Identify important patient demographic information that is missing and contacts veterans to obtain current information to avoid claim processing issues with the insurer

Assist Accounts Management (AM) by responding to QUIC requests received for claims needing policy updates to reduce pay denials and aid in revenue collections

Plan, distribute and balance workload assignments among the IV unit within established work flow protocols in coordination with the Supervisor; Monitors completion of workload and reports work status of the Medical Reimbursement unit to the supervisor

Develop training material and procedures for new employees regarding the insurance verification process to ensure clerical accuracy

Interprets training materials provided through a variety of sources, such as the revenue Cycle Education provided on the CBO website, in-house CPAC training, and webcasts for staff

Access the Huron Tools ONTRAC and QUIC, to process high dollar invoices over $5K and correct insurance billing discrepancies to assist in revenue collections daily

Contacted insurance carriers to request and obtain pre-cert/authorization requirements for both inpatients and outpatients to meet billing requirements, and identifying patients requiring second opinions, assist with the pre-certification process, generate monthly reports and reviewing and explaining insurance coverage with veterans

Direct contact/coordination with Utilization Review (UR) nurses and claim managers to enable those veterans with immediate medical situations to be processed and have care provided in an expeditious manner

Worked in concert with Program Support Assistants (FRT’s) to acquire billing information by verifying Worker’s Compensation accounts and Regional Council accounts (MVA-No-Fault and TORT FEASOR)

Work cordially in a team environment and participate in meetings, sharing ideas and information

Mar 2008-Nov 2009: Health Care Administration (HCA) Emergency Room Patient Access Registrar: Osceola Regional Medical Center, 700 W. Oak Ave, Kissimmee, FL. 40 Hours, Full Time Supervisor; Kerry West; 407-***-****

Daily Duties Include:

As an Emergency Room Patient Registrar, I gathered patient demographics and insurance data to ensure that fees for services were collected in an effort to generate revenue for the Medical Center

During ER visits, I collected an average of $10,000 per month in patient co-payments and ensured all necessary signatures are obtained for treatment.

Obtained prior authorization for treatment and approval codes from the insurance carrier for patients presented for treatment insured by the medical officer

Notified Medical Records for any duplicate unit numbers. Verified all insurance and obtains pre-certification authorization.

Explained policies to patients regarding services, charges, billing and payments for each account; Explained financial options and collects payments for services rendered.

Checked for completed physicians’ orders and attaches them to the patient medical records to ensure that patients are receiving appropriate tests.

Input patient information into a computer system and verify necessary physician referrals and insurance authorizations.

Demonstrated knowledge of occurrence reporting system and utilized the system to report potential safety issues.

Trained personnel on the new Front Office Scanning (FOS) registration system, which increased productivity by 60%

Performed additional functions, such as reception and clerical work

Feb 2007-Mar 2008: Health Care Administration (HCA) Emergency Room Patient Access Registrar: Lake City Medical Center, 34 NW Commerce Dr., Lake City, FL 32025; 40 Hours, Full Time; Supervisor: Susan Martin-Reynolds; 386-***-****

Daily Duties Include:

Interviewed incoming patients, their relatives, or other representatives to obtain identifying or demographical information including insurance and financial information.

Obtained all patient account information, ensuring charts were completed and accurate. Assigned the medical ID number after verification was established

Notify Medical Records for any duplicate unit numbers. Verifies all insurance and obtains pre-certification authorization. Calculates and collects patient payment amounts. Ensures that all necessary signatures are obtained for treatment.

Aug 2005-Feb 2007: Assistant Sales Manager, Advance Auto Parts: 700 N Ridgewood Ave, Daytona Beach FL 32119; 40 Hours, Full Time; Supervisor-Verlon Samuel; 386-***-****

Daily Duties Include:

Supervised and coordinated the activities of twenty-five sales associates on three different shifts, demonstrating my ability to multi-task and make sound business decisions rapidly.

Implemented training for new employees by accelerating transition within the team for faster awareness to team policies and procedures

Created a new display for products with the concept of grabbing the customer’s attention upon entering the store to help focus on hard to sell items, increasing sales by $35,000 over a two- year period.

Provided Do-It-Yourself (DIY) service including battery installation, testing, wiper install, etc.

Executed and trained team members on all store operational processes and procedures, and testing and diagnostic equipment for DIY services

Managed and grew commercial customer relationships/sales, including building and holding team accountable to executing customer action plans

Ability to execute and train inventory systems and store equipment; Coached all team members to deliver on customer expectations (DIY and Commercial); through increased knowledge of training manuals and guidelines enabled the staff to focus on customers’ particular demands and/or needs.

July 2004-Aug 2005 United States Air Force; Non-Commissioned Officer in Charge (NCOIC), Medical Information Systems Management Flight, TSgt (E-6), Malcolm Grow Medical Center, Andrews AFB, MD 20762; 40 Hours, Full Time; Supervisor-Russell Shapland: 301-***-****.

Daily Duties Include:

Supervised resource management functions including flight-level manpower and cost center management for a $1.5M budget.

Managed automated data processing equipment (ADPE) inventory and custodian program consisting of 5,000 items valued at over $3.6M.

Planned and supported the 89th Medical Group's (MDG) 1600-user network security infrastructure including: intrusion detection, firewall, vulnerability scanning, encryption

solutions, Internet proxies, internet security scanning, and network monitoring for 10,853 network nodes, 153 hubs, 23 switches, 5 routers and 43 servers.

Provided network security expertise for facility-wide projects, knowledge and understanding of network security architectures, and the most up-to-date anti-virus information and security patches.

Developed and maintained security plan and certification and accreditation of the 89th MDG network. Ensures Security Awareness Education and Training (SATE) is accomplished by all MDG staff.

Managed, administered, organized, and documented data back-up of the 89 MDG LAN. Installed, configured, supported and troubleshoot six Windows NT domain controller servers, a remote access server and 12 UNIX based application servers.

July 2002 - July 2004: United States Air Force; Assistant Physical Evaluation Boards Liaison Officer (PEBLO) & Temporary Disability Retirement List (TDRL) Monitor, TSgt (E-6), Malcolm Grow Medical Center, Andrews AFB, MD 20762; 40 Hours, Full Time; Supervisor-Carrie Woodland 240-***-****

Daily Duties Include:

Assisted in the operation of the Medical Evaluation Board (MEB) program, coordinated medical board actions within Malcolm Grow Medical Center, and counsel active duty, air National Guard and reserve patients and manage the Temporary Duty Retirement List (TDRL) process.

Ensured disability cases were referred to the Physical Evaluation Board are accurately completed, and fully documented in accordance with AFI 44-157.

Maintained close coordination with the member, medical facility, MPF, legal counsel, and HQ AFPC/DPPD. Interviews military members under consideration for disability evaluation to determine facts on medical history and explains the requirements, eligibility, and benefits available under various programs.

Counseled Active Duty military members regarding TDRL status and the requirement for periodic examinations and re-evaluation of the disability status; Completed and transmitted all forms required to effectively establish a member’s disability retirement on cases requiring an immediate turnaround.

Developed strong working relations with the Casualty Affairs office to ensure that survivor benefits and the various government life insurance programs are explained to the member and their families.

Dec 1996 - July 2002: United States Air Force, Shift Supervisor, Aeromedical Mission Operations Flight, TSgt (E-6); Malcolm Grow Medical Center, Andrews AFB, MD 20762; 40 Hours, Full Time, 240-***-****. Supervisor-Lt Col Christy Martin

Daily Duties Include:

Coordinated ground transportation activities for all air evac missions; oversaw mission operations personnel in conducting patient movement activities and support.

Organized and directed patient operational activities, which included coordination with Tri-Service area MTF's for the timely retrieval of patients to the respective facilities for definitive care.

Utilized the ICD-9 to properly code patient diagnoses for submission to the Defense Medical Regulating Information System computer, a process necessary for the expeditious transfer of patients to Major Military Medical Treatment Facilities around the world.

Created daily report of patient’s datasheet using Microsoft Excel. Revamped flight crew book; provided a more functional handbook for arriving flight crew members; efforts for both items lauded by crewmembers and staff alike--Flight awarded best practice for strategic plan and pre/post flight briefings from combined Joint Commission and Accreditation of Health Care Organization and Health Services Inspection (JCAHO).

Jan 1995 – Dec 1996: Medical Mobility NCO; SSgt (E-5); Malcolm Grow Medical Center, Andrews AFB, MD 20762; 40 Hours, Full Time; Supervisor-James Maxson; 240-***-****

Daily Duties Include:

Managed The 89th MDG Medical Readiness program with over 718 members assigned.

Prepared statistical data covering deployments and training data for presentation to the Medical Readiness Staff Function.

Primary member of the Medical Control Center Disaster Team. Served as Flight Medical Expense and Performance Reporting Monitor.

Managed of the Mobility Database, a computer generated program used to ensure that all training requirements and medically necessary equipment are up to date and completed, thus eliminating shortfalls. Database format used as the benchmark for the entire 89th Airlift Wing and rated as “Best Practice” in the Air Force.

Delegated as primary Readiness Custodian-duties included the completion of all mobility items for deployment to include shot records, dog tags, wills, Geneva Convention cards; keeping these items accurate and up to date are crucial to ensuring a seamless and rapid deployment of personnel at a moment’s notice.

Worked closely with Air Wing planners and Personnel Readiness unit to ensure that personnel deploying for real-world destinations were adequately prepared and kept informed of ever changing requirements.

Maintained the Status of Resources and Training System (SORTS) document; a comprehensive plan that describes responsibilities and procedures to perform the unit’s mission and was critical in building and maintaining highly effective medical response.

Coordinated Medial Readiness training; expertly trained 700+ members on disaster Ops--CRT equipped for any contingency

Feb 1984 – Dec 1994: Medical Mobility NCO; SSgt (E-5); 325th Medical Group: 340 Magnolia Cir, Tyndall AFB, FL 32403; 40 Hours, Full Time: Supervisor: MSgt Arron Rowell; 850-***-****

Daily Duties Include:

As NCOIC, Medical Readiness, ensured mobility deployment members were mission-ready, raised Tyndall AFB Individual Medical Readiness rating from 85 to 95%

Supervised cargo documentation and movement control units for all transportation modes;

supervised freight, cargo, personal property, and passenger travel at installation level; checks, reviews, and consolidates movement requirements

Ensured appropriate transport capability and prepares movement schedules; assisted in planning transportation requirements for logistical support; supervises any diversion or transfer of personnel, freight and material shipments for all modes of transportation; assisted with all training and readiness issues in the unit.

Managed the funding for training, exercises, personnel and equipment through an internal

planning, programming, and budgeting system.

Provided functional oversight and guidance to MAJCOMs on all aspects of medical readiness, to include policies, procedures, and publications; deployment and operational information and taskers; training development and opportunities; installation medical response guidance; and resource allocation.

Aug 1981 – Jan 1984: United States Air Force; Medical Administration Specialist, Moody AFB, GA 31699; 40 Hours, Full Time; Supervisor: SSgt Christopher Rausch; 229-***-****

Daily Duties Include:

During this period, I maintained a wide variety of specialties to include inpatient and outpatient records processing; also performed the duties of third-party liability clerk, inpatient ward clerk and patient referrals clerk.

As an Inpatient Ward clerk, I was normally the first person encountered on the ward. I maintained all organized documents associated with a patients’ charts.

coordinated within the Medical Treatment Facility, as well as in the private sector to arrange necessary tests; ensuring that each document associated with that patient was properly identified to avoid mix-up or misplacement; arranged for patient transportation to their destination after the inpatient stay was complete.

As a Clinical Records Clerk, I maintained all inpatient records files within the MTF. I created an inpatient records Cover Sheet on each record that came in contact with.

I annotated each cover sheet with a diagnosis and a diagnosis code, which required that I have a working knowledge of ICD-9/ICP-9 code books and medical terminology to properly code the file

As a Third Party Liability clerk, I Collected valuable patient data; processed Third-Party-Collection insurance forms for the Medical Group recouped $20K

Maintained Injury Log monitor; accounted for 450 patients/forwarded documents to legal--prevented $50K in off-base insurance costs

As an appointment technician, I scheduled appointments, initiated telephone consultations, and verified patient eligibility for care & treatment

In the absence of the CHAMPUS Monitor, I stepped in and coordinated necessary outpatient medical appointments with off-base and nearby military providers resulting in a $77,000 savings to the medical group, which would have been used for toward non-participating CHAMPUS health care providers

Education:

29 Jul – 1 Aug 2013: Emerging Leaders Courses 1 & 2, Orlando, FL

March 2013: Six-Sigma Green Belt Training, Orlando, FL

21 July 2012: Columbia College, Columbia, Missouri-Orlando FL Campus Bachelor of General Studies with Management Certification, 2.75 GPA

Jun 2005: Community College of the Air Force, Health Service Management, 68-94 semester hours

Mar 2005: Workgroup Management Course (Level 1 & 2), and Local Procedures Training

Oct 2002: United States Air Force NCO Academy, Maguire AFB, NJ

Apr 1999: Seven Habits of Effective People Course

Sep 1991: United States Air Force NCO Leadership School, Tyndall AFB, FL

Aug 1984: Coding patient illnesses and procedures using ICD and ICP-9/10 manuals from Ft. Benning, GA

Sep 1984: NCO Prep Course, Tyndall AFB, FL

Oct 1983: Georgia Military College, 3.33 semester hours 4.0 GPA

Aug 1981: Daytona State College,12.00 semester hours, 2.8 GPA

Job Related Skills:

Ability to work effectively with other employees, patents and external parties

Skilled in Vista and Insurance Capture Buffer (ICB) for insurance verification

Proficient in Huron tools ONTRAC and QUIC to assist in expediting collection of revenue for the facility.

Excellent typing and computer usage skills, including Microsoft Word and Excel proficiency.

Ability to relate with people of diverse backgrounds, provide excellent customer service and solutions to problems.

Knowledge of drug cards, medical insurance terminology, medical benefits, and billing process.

Experience with patient assistance and government programs.

Ability to work independently, give attention to detail, prioritize and perform several tasks together without losing concentration.

Effective in communicating clearly in writing and in speaking without being misunderstood



Contact this candidate