Deborine C. Lane

*** *. ******* ****• Las Vegas, NV 89101

702-***-****

ad0nys@r.postjobfree.com

All Lines Claims Adjuster

Versatile performer with knowledge and experience in guiding claims processing for Property & Casualty, Medicare and Managed care plans, demonstrating impressive attention-to-detail and customer service. Well versed in researching and analyzing available data and regulations to determine secondary payer liability for workers’ compensation, automobile no-fault, and group health plans. Talent for training, overseeing, and mentoring claims staff. Comfortable in establishing productive, trustful relationships with critical stakeholder groups, such as policyholder's, attorneys, employers, other 3rd party administrators, and insurance company staff. Proven ability to compile and track complex information, and ensure adherence to quality regulations and timeframes. Background well suited to claims recovery operations for workers’ compensation, automobile accidents, and other liability issues.

Key Strengths

Property & Casualty• Attention-to-Detail • Relationship Management • EPIC Medicare / Managed Care • Workers’ Compensation • Automobile No-Fault Research / Analysis • Timeline / Quality Compliance • Multi-tasking • Customer Service PROFESSIONAL EXPERIENCE

ACCLARA – Houston, TX

Patient Account Services Rep, June 2022 to Sept 2022 Deliver high-quality patient experience through inbound and outbound call resolution within established protocols and a first call resolution. Accurately receive and process electronic payments from patients. Identify customers’ needs by, clarifying information, researching, and providing solutions. Review, Interpret Patient Statements/EOB and Balance and basic knowledge of Client Contractual Terms/Agreements (as needed). Obtain supporting documentation regarding Patient/Client follow-up efforts. Identify contractual and administrative adjustments. Assist and Resolve Patient Inquiries/Request within 24–48-hour period.. Meet personal/team qualitative and quantitative metrics WALMART-Houston, TX

Digital Personal Shopper, July 2020 to June 2022

Responsible for identifying clients needs and locating products that meet those requirements.

The role has a sales focus that builds long-lasting relationships with clients providing exceptional service and ensuring all client goals and needs are met. Metasense - West Berlin, NJ

Call Center/Customer Service Rep, November 2018 to March 2019 The customer service representative supported the organization's mission and purpose by providing first-line customer support for a diverse portfolio of customers. Handled inbound inquiries from members, pharmacies, and prescribers in its Philadelphia Contact Center, maintaining the standard for service levels, including research of relevant issues; and meeting all performance standards required of the position. Analyzed, evaluated and worked to resolve customer inquiries and issues. Interacted with customers in a courteous and professional manner. Effectively communicate issues and resolutions to customers and appropriate internal staff. Use multiple screens of information simultaneously to address customer needs. Answer prior authorization inquiries calls as well as research and resolve benefit issues. Reviewed utilization requests and appeals for new Community Health Choices(CHC) participants.

Emblem Health Care, New York, NY

Medicare Secondary Payer Recovery Contractor Specialist (MSPRC), 2006 to 2014 Charged with guiding case workload with minimal supervision, effectively interpreting federal law and Centers for Medicare and Medicaid Services (CMS) instructions in making sound decisions. Determine potential secondary payer interest by compiling data from Medicare records, beneficiaries, providers, attorneys, and employers and other 3rd party administrators. Determine liability for workers’ compensation, automobile no-fault, and group health plans by researching and analyzing available data and interpreting Medicare secondary payer regulations. Interface with 3rd parties to determine transaction accuracy.

Optimized cost savings by identifying mistaken Medicare primary payments, initiating recovery and issuing conditional payment letters.

Generated pre-payment savings by updating Common Working File (CWF) via Electronic Correspondence Referral System (ECRS) in response to changes in beneficiary Medicare Secondary Payer (MSP) status and coordination of benefits (COB). Maintained productive, timely, and high quality case workload operations, accessing up to 10 separate programs simultaneously to analyze, interpret, and process information. Earned highest employee review ratings for 4 consecutive years.

Played important role in company’s ability to retain critical government work by transitioning from subcontractor to contractor status.

Rural Metro Ambulance, Syracuse, NY

Patient Account Representative, 2004-2006

Held accountable for inputting patients’ trip ticket information into billing system, confirming patients’ insurance eligibility and benefits and posting payments. Audited patient charts to ensure adherence to federal and state government guidelines.

Deborine Lane

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Rural Metro Ambulance Continued…

Demonstrated impressive accuracy and attention-to-detail in processing up to $1M in tickets monthly with minimal issues. Secured payments from providers within relatively short time period. Achieved cost savings of $100K annually by assuming responsibility of four other staff members, doing everything necessary to ensure high quality and timely completion of entire workload. Contemporary Personnel Staffing, Liverpool, NY

Customer Service Representative, 2003-2004 Advised claimants on withholdings and taxable benefits and distributed W-2 forms. Prepared invoices, reports, memos, letters, financial statements, and other documentation. Well versed in using word processing, spreadsheet, database, and / or presentation software. Built strong knowledge and expertise in document imaging processes and software tools.

CAREER NOTE

Established successful career in medical claims processing by serving in Claims Examiner roles for Insurance Overload and Prudential Insurance. Also worked as Contract Representative for U.S. Internal Revenue Service, processing delinquent taxes and returns, filing financial information from taxpayers to determine ability to pay, and filing levies and liens. MILITARY SERVICE

Served in U.S. Army Reserves as Administrative / Personnel Specialist in guiding wide range of office operations, including payroll, staff supervision, and recordkeeping. Honorably discharged. EDUCATION / CERTIFICATION

Texas All-Lines Adjuster License# 2850554

Texas Licensing Company, Houston, TX

Associate of Health Sciences and Medical Billing (2012) Ultimate Medical Academy, Tampa, FL

COMPUTER / TECHNICAL SKILLS

Microsoft Office Suite * Xactimate 1 * HIPPA * ICD-9 * ICD-10 * CPT * HCPCS * HIGLAS * Diamonds * FISS * REMAS * Invoicing

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