Motor Vehicle Operations Supervisor
Resume:
Janelle Milligan
************@*****.***
SUMMARY
Enthusiastic, motivated and talented professional operations supervisor. Responsible person and computer literate. Record of success and increased responsibilities with proven leadership abilities working independently as well as in a team, handling multiple tasks with strong skills in professionalism, integrity and communication. Looking to obtain a challenging position offering internal growth ACCOMPLISHMENTS
Extensive knowledge of New York Workers’ Compensation and No Fault motor vehicle claims. Managed daily inventory of over 12,000 accounts, which was then reduced to around 4,000 accounts due to the success rate of collections and aging concerns being addressed. Team account aging was 51% when I took over the team. My staff and I reduced it to 9% in less than 2 years. Our accounts that were not worked/noted in 30 days were at 0% and our collections were around $2 million per month, the top grossing team in the office. More recently, I have additionally become quite verse in Massachusetts motor vehicle claims as well as medical carriers – including but not limited to Harvard Pilgrim and Tufts EXPERIENCE
Bottom Line Systems/Revecore – Crescent Springs, KY 09/19-present
General underpayment review specialist & onsite client liaison
● Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client
● Secondary responsibility is to be the onsite liaison, as the face to the client as their vendor. I also have the only vendor access to perform duties such as rebilling claims through Epic and obtaining itemized bills
● Have built strong, lasting relationships with clients, payors and BLS personnel and am a BLS certified mentor
● Review insurance contracts as well as payer policies with thorough understanding of payment methodologies
● Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
● Contact insurance companies to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of the client
● Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
● Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other BLS personnel
● Direct claims to, coordinate with and support BLS specialty units
● Daily compliance with federal and state laws, company policies and procedures
● Use of high functioning mathematical and comprehensive skills: ability to calculate rates as well as research issues or abnormalities to find the root cause of the issue or trend
● Read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
● Define problems, collect data, establish facts and draw valid conclusions in order to determine underpayments
● Use of strong customer service orientation with excellent interpersonal and communication skills Janelle Milligan
************@*****.***
● Full end of month responsibilities, including but not limited to; running weekly and monthly multiple full client reports, checking accuracy and finalizing accounts in multiple systems, discrepancy QA and communicating errors amongst other departments, completing client invoices and final monthly checklists. Andover Oral Surgery - Andover, Ma 11/17-05/19
Billing representative and aging specialist
● Manage the entire office inventory and review the aging on daily basis, and on a larger scale monthly
● Follow-up on all accounts with medical and dental insurance carriers
● Send out corrected claims, claim reviews and draft formal appeals when necessary
● Send out the initial billing of all medical and dental claims to the appropriate carriers - while first confirming all insurances, demographics, diagnosis and coding to be appropriate and correct (ICD-10, CPT and CDT)
● Perform large amounts of QA on other staff members
● Assist in obtaining and calculating benefits and estimates for future planned procedures and provide them to the patients
● Print, review and mail all monthly patient balance statements as well as working with the collection agency to refer delinquent accounts to them
● Specialty projects on an as needed basis deemed fit by the office manager or the doctor
● Reviewing EOBs in depth, coordinating benefits with all carriers and take payments via phone The Outsource Group/Parallon - Wakefield, MA 2009-2017
Operations Supervisor for a specialized NY Workers Compensation team 01/15-04/17
Team Leader 04/13-01/15
Claim Representative 04/09-04/13
● Ran a team specializing in workers’ compensation claims for the state of New York
● Used personal knowledge and investigational skills to determine payments and status of claims of workers’ compensation and motor vehicle UB04 facility bills
● Modeled for my staff so that we met and often exceeded quota of daily accounts worked, to completely satisfy each individual customer
● Typed/data entry/utilized updated skills in new processes
● Used ICD-9 and CPT codes on a daily basis, as well as being familiar with medical terminology
● Assisted client contacts directly in their daily questions & concerns, and addressed them in a timely fashion
● Kept communication lines open, and worked one on one with the client(s) on weekly projects and quotas as their direct contact
● Utilized good customer service skills to get claims processed by the insurance carrier as well as assisted patients with account questions or concerns
● Reviewed and processed correspondence from multiple parties to ensure proper and timely billing, while following state rules and regulations
● Ran a team of 6-10 claim representatives at a time
● Answered questions, approved time off requests, processed the payroll, assigned/reviewed and completed weekly work plans, ran weekly team meetings, quality assurance checks on all team members including offshore representatives work, etc.
● Attended weekly Supervisor operations meetings and weekly meetings with our offshore India team.
● Performed quality assurance daily audits to assist on and offshore staff improve work quality
● Participated in the hiring of new employees, including the interview and screening processes COMPUTER SKILLS
Janelle Milligan
************@*****.***
Microsoft Office: Word, Excel and Outlook. Epic, OMS Vision, Web Extender scanning, SSI, Groupoint, FACS, Application Extender scanning program, Integration Bridge, OnBase. Also prior knowledge of Stars system, Reynolds and Reynolds, and TIMS has been utilized along with data entry into specific medical programs including SMS for Spaulding Rehab, Meditech, and the Medicare system.
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