Experience Healthcare Insurance Analyst/Examiner

Deanna Buechel College Point, NY *****

********@*****.*** http://www.linkedin.com/in/dcooperbuechel

H: 718-***-**** / C: 917-***-****

SUMMARY OF QUALIFICATIONS

Focused and dedicated health insurance professional motivated to provide business ethics, uphold the code of confidentiality, courtesy to subordinates, and the public.

Work skills gained have proven to be transferable and knowledgeable to various business industries.

Strengths include: • Strong Medical Ethic • People Oriented • Critical Thinker

• Self-Motivated • Analytical • Energetic • Dependable • Team Player • Decisive

• Organizational Development • Complaint and Problem Resolution

• Strong Interpersonal & Communication Skills • Detail Attention

SKILLS SUMMARY

Medical Insurance Examining Background, Medical Claims Processor, Knowledgeable with HCFA (CMS) Medicare/Medicaid, Commercial Health Insurance Carrier Guidelines, CPT, ICD, HCPCS coding, terminology, CDT, Appeal and Grievance Adjudication, Resolution billing disputes, collections, Interpret problems/resolution for the consumer and medical profession, Troubleshoot complaint handling with regard of explanation of policies and regulations, Interpersonal Skills with the public, communication with various insurance carriers, Analytic, Research, Investigative Skills, Eligibility verification/determination. Oral and Written Communications, and Proofreader.

Computer Tools/Skills include: PeopleSoft, Kronos, IDX Hospital, Microsoft Office Suite, Outlook, Oasis, E-Oasis, Imagewrite Pro, NPDB (National Practitioner Data Bank, E-Law, Unified Court System of NY State, Professional Conduct, Orthoware, Easy Dental, Ortho 2, Lytec Medical Practice Management, MediSure Health Insurance Manager.

PROFESSIONAL EXPERIENCE

ShopRite SuperMarkets, Queens NY (part-time) 2016

Human Resources/Administrative Assistant

Applied interpersonal relationships, skills for active listening directly with the direct public and all levels of management providing communication of information.

Conducted orientation and OSHA class for new employees, arrangement of in-house training.

Assisted, verify, process, maintained documentation relating to personnel activities for staffing, recruitment, grievances, performance evaluations.

Survey conducted of department heads to review their staffing requirements, compiled information presented to the HR Coordinator.

Review, screened, process applicants for evaluation of qualifications during pre-screening process.

Assisted with review of all job descriptions insuring up-to-date and realistic.

Maintained complete records of all contact with job candidates.

Competencies with pre-screening applicant resumes, schedule and conducted interviewing, problem solving, oral and written communication.

Donald J. Fager & Associates, East Meadow, NY 2002 - 2015

Excess Assistant Medical Malpractice Examiner

Communicated with physicians and staff, numerous defense counsel conveying and explaining contract terms regarding new lawsuits, case updates; kept unbiased information with following HIPAA guidelines.

Endorsed techniques for recognizing potential high risk medical malpractice cases.

Interacted with defense attorneys in understanding of excess policy guidelines for insured’s, interacting with underwriting insurance department regards to policy and possible revisions, legislator endorsement.

Involvement with conferences in the negotiating of excess policy for satisfaction of settlement under the primary malpractice policy.

Managed high volume of excess malpractice insurance cases through process of beginning to settlement.

Queens College/CUNY/Continuing Education Program, Flushing, NY 2000 - 2007

Adjunct Lecturer and Instructor, Healthcare Careers (part-time)

Adult Courses Lecturer and Instructor: Fundamentals of Medicare and Medicaid, Commercial, Worker’s Compensation, and No-Fault Insurance.

Coached, Instructed, taught, and inspired adult students to pursue a transition toward the healthcare industry by means of employment for medical office, institutional and or health insurance industry, along with advancement for those in the related field with further knowledge of Medicare and Medicaid insurance technique.

Applied learning rule and regulations adhering when applying prepayment, governmental guidelines for a smooth transition of claims processing.

Instructing techniques to apply when appealing denials based on medical documentation and medical necessity due diligence of coding with various levels of appeals process.

Touch basis on Social Security and the importance of consumer education, short syapse of Medicare history, various divisions, the importance of the system.

Instructing adult student’s with pursuing a career with a Medical Office, necessity of information, learning techniques of running the office in a professional manner with daily dealings of patient communication, record keeping, appointment scheduling, claim submittal.

Simplified the understanding of medical claim forms, importance of gathering patient, subscriber information, adhering to compliance regulations for the office personnel.

St. Joseph’s College, Brooklyn, NY 2000 - 2002

School of Adult and Professional Education, Graduate Program

Administrative Assistant for Assistant Dean

Created database based on information obtained from Department Heads for accessibility for a smooth transaction, along with interacting with all superior offices.

Review applicants completed files, ensuring qualified and pertinent information is submitted for entry to the college’s Graduate program.

Setup, Conduct appointment interview with Graduate counselors’ and or myself.

Developed, Diversified Systematized, Organized with maintaining reports, spreadsheets, databases, manuals, student files uponsubmittin completed files to the supervisor and director.

General Administrative Functions: oversaw daily routines: generate letters of acceptance, memos, textbooks requisitions for students and faculty, accounts receivable, website inquiries, reconcile problems, Supervised, Coach student workers.

Involvement with event planning arrangements for commencement activities.

North Shore Imaging, Great Neck, NY 2000

Medical Collector/Biller (contract)

Collection on past non-payment insurance accounts.

Electronic appointments, telephones, follow-up on authorizations from insurance carrier’s confirmation of appointment’s end of day.

Setup of patient billing charts.

Medident Group, Whitestone, NY 1996 - 2000

Insurance Alliance Administrator for Orthodontist and Medical Secretary for Periodontist

Applying listening techniques with regard to complaints, interpreting, resolve billing disputes, examine policies’, oversaw collection on delinquent accounts, eligibility determination.

General Office Duties: Trained, Overlooked office personnel usage of office system software for computerization.

Organized, maintained, updated patient files, validate insurance, provider manuals.

Submittal of dental insurance claim forms to carrier, obtaining precertification for procedures to be performed.

D&C Healthcare Problem Solvers, NY 1992 - 1996

Medical Claims Processor and Appeals Resolution

Increase cash flow via paper and electronic claim processing, result over $3,000 backtracking account payable / receivable in a span of nine months for urologist practice.

Medicaid payment recovery from past neglected claim processing for psychology practice, retrieval of 50% of collections on obtained overdue accounts.

Organization of consumer health insurance EOBs, appeal submittals for discrepancy of denial services, reconsideration for review for payment.

Additional Duties: Maintained, Organize, Process health insurance claims for the consumer’s, health care professional, Track and organize payments. Workup claim submittal to primary, secondary and third party carriers. Clear communication with various health insurance carriers. Continuous education of health care issues.

Empire BlueCross and BlueShield of GNY, New York, NY

1976 - 1993

Policy Manual Coordinator, Human Assets

Coordinate, Administrate updating policy publications for the private commercial sector medical claim processing units, consisting of 9,000 employees, according to policy guidelines set forth by Medical Staff.

Conduct, Evaluated, Updated, Distributed policy manual revisions implicated rom medical staff, claims training personnel, corporate staff members.

Senior Appeals Analyst/Advanced Claim Analyst (Utilization Review Pre-Payment Medicare Part B )

Expedited Grievances Resolution by workflow and auto-prioritize ases that enables better routing with provisions to manage escalations and cases exceptions.

Ensure timely and effective resolution of appeals and grievances received.

Ensure better compliance with processing reports and extensive audit features to continually monitor milestones and resolution timelines.

Correspond with internal, external medical professions, corporate medical staff on adjudication of medical claims, adhering to prepayment Medicare Government guidelines.

Contributed to consumer investigations according to flag guidelines.

Secretary, Marketing Division

Created, prepared flowcharts, upkeep expense reports for corporate commercial marketing division.

Arrange conferences, travel arrangements, health insurance secretarial functions.

EDUCATION

Master in Organizational Management Leadership, Ashford University, Clinton, IA

Bachelor of Science in Organizational Management, Ashford University, Clinton, IA

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