RUTH H. BAKER

***** ***** **** **.

Clermont, FL. 34714

Phone 352-***-****: 708-***-**** (cell) 352-***-**** (fax)

EXPERIENCE:

May 2008- 8/30/2019. – CBC, LLC, Crown Point, IN. - remotely since 9/2014 when I moved to Florida. Billing Administration Manager for an Ambulatory Surgery Center owned by 2 physicians. Managed two implementations of this ASC’s billing with Athenahealth. It was moved from one tablespace to another. Anesthesia and Surgical assist billing was added. Managed the Billing process and reviewed all payments and billing adjustments. This is an out of network facility that does not take Medicare or Medicaid or any government programs. Developed a very thorough pre-cert program to identify in and out of network benefits and any special rules and/or needs for pre-approval.

Sept. 2006 – December 2012 – Billing Manager for Arthur H. Katz. M.D. S.C. in Munster, IN. – managing the implementation of Athenahealth as the billing program and implementation of an updated fee schedule and implemented billing rules while training and managing new staff members. I also performed and managed credentialing. I revamped the employee benefit program and obtained quotes for life, health and dental coverage. This is an Otolaryngology practice including Audiology, Allergy and Vestibular testing and therapy.

September 2005 – September 2006 – Claim Strategies, Inc. (Company closed) Claim Examiner Temporary Assignments at an HMO updating the provider file, at a Union Paying Claims and at Midwest Operating Engineers paying claims.

August 2004 - May 2005 Professional Benefit Administrators, Oakbrook, IL Claims Research Team Member. Responsible for development of an audit review program and management of the audit review process. Responsible for the multiple surgery Q and claim audits and appeals. Processed and corrected claims. Participated in claims reviews and appeals.

Sept. 2003-March 2004 Allied Benefit Systems, Chicago, IL Director of Claims Administration Responsible for the management of the Rapid Response Team. Rapid Response processed all claims adjustments, refunds, overpayments and undeliverable mail.

Jan. 2002-Sept. 2003- Hinz ConsuIting Service, Chicago, IL Vice-President and Employee Benefit Consultant - Employee Benefit Consulting for School Districts and clients from the private sector. Provided plan and vendor evaluations, completed plan changes including Plan Document and Summary Plan Description amendment. Communicated Plan changes to TPA's and plan service vendors. Evaluated monthly plan reports and identified areas that need to be investigated. Reviewed vendor contracts and performed TPA operation and claim audits. Assisted in the marketing of a public entity employee reinsurance program. Assisted Human Resources in obtaining quotes for company Section 125 and 132 Plans and evaluating company Medical/Dental Plan choices and renewal rates. Assisted clients in evaluation of difficult claims. Trained School District Personnel on the contents of their benefit Plan and establish procedure for protection of privacy of claims information.

Nov. 1999 Jan. 2002 Long Claim Service, Inc., Matteson, IL (Company Closed) Manager, Marketing and Sales and Claim Manager

Managed the claim department, reducing backlog from 6 weeks to zero in 5 weeks without overtime. Managed a system conversion, moving 30 clients in 6 weeks. Responsible for claim appeals and training of claims analysts and claim audits and management of claims and clerical personnel. Additional responsibilities included marketing, sales and retention for this Third-Party Administrator of partially self-funded medical, dental, disability and Vision claims. Developed relationships with brokers, reinsurance carriers, PPO's PBM's, UR firms and other ancillary providers. Obtained bids for new and existing clients from reinsurers and procuring PPO, UR and PB services for bids or clients as needed. Increased the client base through development and maintenance of broker relationships. Answered RFI's and RFP's and develop marketing material, make client presentations and assist with open enrollment

July 1994- Nov. 1999 Insurance Overload Systems, Oakbrook Terrace, IL Final position Midwest Regional Accounts Director - Life and Health Claims

Original position was Branch Manager - promoted to Regional position in July 1995 (Company Closed) - Branch Management and marketing of insurance temporary staffing services for life, dental, disability and managed care – both locally and regionally. Branch management including hiring, training and development of staff personnel. Increased branch client base by over 200 clients allowing large growth in the branch. Screened, interviewed and placed temporary candidates. Counseled candidates and provided client service to new and existing clients.

Affiliations: Chicago Claim Association and Midwest Claim Conference 1993-2000. Board of Directors -all positions to President. Also had various positions at the claim conference including education and obtaining speakers.

SIAI – Self Insurance Association of Il – Secretary for 7 years.

Education:

Presently enrolled in an online CPC class at MCHC for CPC certification

3 years of college in biology education and business.

HIAA classes with honors.

ICA (International Claim Association classes and have ALHC (Associate Life and Health Claims) certification.