RESUME OF

L. MARIE RANSLEBEN

L. Marie Ransleben

OBJECTIVE:

Opportunity to contribute my acquired skills within a growing Healthcare environment.

EDUCATION:

Associate degree-Mid Management, Austin Community College

Microsoft-Email, Word, Excel, Works, Money, Publisher, Power Point

Software systems – CPSI Trimmed, Lytic, Medisoft, E-meds, Encoder Pro, FACTS, Medisoft, Eldorado, Trucare, Aetna, AHH, Encoder Pro, Maxxvault, Redcard, Optum, Jiva, iiput and Availity.

Billing coding and collections using CPT, ICD-9 and 10, HCPCS, Modifiers. POS, Rev Codes, ticket information for accidents and other violations per city, county, attorney websites etc.

Attended CPC Coding certification classes.

PROFESSIONAL WORK EXPERIENCE:

April 2023 – Current, Guidewell Florida Blue dba Webtpa, San Antonio, TX, Claims Examiner, Tanna Rose, Supervisor, 405-***-****

Currently working as Claims Examiner on company’s largest plan administered by company is Prudential. The system used to pay these claims is iiput system. Claims are divided up by alpha split to examiner to work and type of claim when paying. The claims are unscrubbed and examiner is responsible for confirming all information on claims such as paid to member or subscriber, provider information (TIN, NPI), amounts, POS, REV code and if the correct benefit feeds through the system and whether it requires a pre authentication; which may be in system referrals or we have to lookup in Jiva system to see if it is on file. Company requires 100% accuracy.

November, 2022 – March 31,2023 Transworld dba Convergent USA, Florida, Collections Specialist, Erin Bryne, Supervisor, 540-***-****

Third Party Administrator for individual companies administering collection practices for the hiring company. Ability to view available notes and dates of service seen in hospital, as well as insurance information, who is responsible party, current contact information. All information has to be contacted and confirmed. Sometimes we would have to contact individual for information or City, State or highway department that issued ticket for additional information to file outstanding charges. Hospital system available for collection of data as well.

Nov. 2021 – October 2022 Boon-Chapman, Remote-Claims Analyst. Adam Dominquez, Manager-Green Team, Patricia Granberry, Supervisor

Third Party Administrator for Individual companies administering plans (self-funded, PPO, HMO, etc) with specific benefits. Ability to read plans and apply benefits accordingly. Coordinate Benefits either on a carve out basis or coordination basis according to the birthday rule and whether a policy is active or retired employee, if spouse is working, disabled or on ESRD, or cobra. Trained on Adjustment’s for underpayments, overpayments, appeals, on all types of claims. Plan benefits that require pre auth and which one’s don’t are very specific on plans. Knowledge of NSA guidelines, plan benefits that wrap benefits.

2018-2023, Blue Cross/Blue Shield, Independent Contractor for Complaint Appeals Board and attend monthly CQIC meetings (remotely). Danielle Peters

Escalated complaint review by all appropriate parties to arbitrate and review file documentation to process and make recommendations based on Plan provisions or have been paid according to plan or consider if this is out of plan mileage range or if an exception should be made and consideration be given as transitional care.

Attend CQIC monthly meeting to process meeting reports on monthly, quarterly reports by departments reporting to Clinical Director. Reports include systems, trends, and turnaround times, new plan products, services, etc. listen and suggest recommendations to develop and improve process, ask questions, and contribute opinions.

2006 to Current, Realtor (State of Texas), Independent Contract, Fathom Realty, JR Russell, Broker (Retired)

Credentials include Texas Affordable Housing Specialist, Short Sales/Foreclosure Sales, Seller Representative, Residential Construction Consultant, Graduate Realtor Institute.

Specializing in Residential, Land/Ranch, and Leases. Includes all phases of sales – marketing, accounting, socializing/networking, compliance of regulations and laws regarding Texas real estate law.

2005-2006, Pathology Reference Lab, Carl Evans, MD - Pathology Lab Assistant

Prep and collections of surgical specimens from hospitals departments/individual physicians; for slide review by pathologist analysis. Knowledge of Hospital Billing system for documentation and billing purposes.

2005 to 2003, Claims Manager/Collections, Independent Contractor- Self Employed

Knowledge of HIPAA regulations, ICD-9, CPT and HCPCS coding to bill and rebill corrected healthcare claims including Physician healthcare, Personal Injury Protection, Workers Comp and Healthcare claims for HCFA and UB billing, electronically and paper claims.

1999 to 2003, Fiserv (Benefit Planners), Boerne, TX - Sr. Claims Analyst – Michael New/Lee DeLuna/Kathy Galloway, Supervisors

Third Party Administrator for Individual companies administering claims processing adjudication, analyzing appeals, pre-authorized services, and adjustments on individual accounts. Broad knowledge of documentation, communication logs, project management using FACTS database software and attention to individual plan details for accurate payment of claims. Training for new plans and auto adjudication improvement of workflow. Also training in setting up systems/database software to pay according to individual plan specifications. General knowledge of company software for all phases of the claims processing. Work closely with all interrelated departments on assigned projects.

RELEVENT WORK HISTORY

10/1998-2/1999 Customer Service Rep. Texas Municipal League

7/1996-10/1997 Team Lead/Claims Analyst USA Health Network dba Fountainhead

5/1992- 7/1996 Medical Director Administrator Kerrville State Hospital

8/1991-5/1992 Clinical Director Secretary Hill Country Memorial Hospital

7/1982-8/1991 Support Staff Supervisor TXDOT – Lemon Law Division

QUALIFICATIONS SUMMARY:

6 Years – Acknowledge and listen to escalated Appeals for decision to agree or overturn based on information presented.

6 Years – Attending and analyzing data provided at Clinical Quality Assurance Meetings for possible improvements.

6 Years – Knowledge of CPT, ICD9 and HCPCS coding and their usage for appropriate billing.

6 Years – Claims and Collections: All types Medical, Hospital, Workers Comp., PIP, subrogation, Appeals

and adjustments etc. Processing claims, customer service, documentation requirements.

Understanding of Claims Software (FACTS) systems with ease

15+years – Administrative experience for and with professionals at all levels.

4 Years – Supervisory and Management of support staff.

15+Years – Understanding of HIPAA, Birthday Rule, NSA and COB guidelines regulations and requirements. Customer

Service, expertise in listening, problem

solving and referring to appropriate resource.

EDUCATION AND TRAINING:

• Associate Degree in Business Management, Austin Community College

• Realtor, Texas Board of Realtors

*CPC Coding training (not certified)

REFERENCES:

Kathy Galloway, 210-***-****

Michael New, 210-***-****

Lee DeLuna, 210-***-**** or 972-***-****

Russell Harding, 512-***-****

Carl Evans, 830-***-**** or 830-***-****

Danielle Peters, 972-***-****

Tanna Rose, 405-***-****

Erin Bryne, 540-***-****

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