Life Insurance Medical Billing
Resume:
Debra Lee Hornung
*** ***** ******, **** *****, NJ 08753
(H) 732-***-****
****-******* **********: a Subsidiary of Anthem
Medical Management Specialist: Role managing care and services for our MCO (Managed Care Organization) members in GBD (Government Business Division). I have established a strong collaboration with Case Managers to coordinate health care services by facilitating, scheduling and arranging a variety of treatment and health care plans.
Additional responsibilities:
Provide clinical support: including coordination, monitoring and tracking health care services
Interfacing with other staff members
Monitors telephone queue and provides coverage as directed
Acts as a resource person for Case Managers and other Units based upon Amerigroup/Anthems policies and procedures
Monitors ongoing communication with service providers
Participates in internal and external audits
Maintains member confidentiality
Participates in Quality Improvement
Reviews benefit systems
Collaboratively works with other department
Utilizes excellent customer principles to assist internal and external individuals
Utilizes knowledge of community resources
Completes referrals to Case Managers
Complete assignments and projects in the time frame allotted
2002 - 2012 Amerigroup Community Care Iselin, NJ
Senior Case Specialist Responsibilities:
Direct contact with members and physician both participating and non-participating
Manage Medicaid recipients and aid them in obtaining the medical treatment, transportation or authorizations needed
Direct contact with local DYFS offices and DDD Case Workers to obtain updated demographics and information on Foster Care placement and DDD members
Update Clinical Pathway Log for Case Managers
Run a monthly report of newly enrolled members to obtain DYFS or DDD caseworker name and phone number, current demographics of member
Keep the ECF HRA Database up to date with Member information
Use the State System (MEDM) to coordinate disenrollment, status change and update Foster Care information
Proficient in Amysis system, CPT and ICD-9 codes
Work with Complex Needs Assessments and Case managers directly
Developed and worked the IT department to automate our letters and a signature on each letter
Received STAR award for outstanding employee
DYFS Phone Log Report : review to determine status of member
DU/Pend Report: review to determine eligibility of authorizations and case managers
1997 – 2002 Aetna Cranbury, NJ
Full Service Consultant
Answer incoming calls from members and providers
Liaison between benefits area and client/members
Provide technical support to new hire/trainees
Recalculate haste customer complaints
Handles all Medicare, Medicaid and Third Party Liabilities
Working knowledge of ICD9 and CPT Codes
Received a NOTT ( Night on the Town) award for being an outstanding employee
1996 - 1997 First Option Red Bank, NJ
Claims Examiner
Handled PPO, HMO and Point of Service Plans
Direct contact with participating provider and members
1995 - 1996 Pediatric Medical Group Brick, NJ
Medical Billing Supervisor
Supervised and managed all aspects of the Billing and Insurance for six physician practice
Manage the day to day operations of the clerical and front desk staff
Working knowledge of ICD-9 and CPT codes
Totaled and balanced each receptionist drawer at the end of each business day
1989- 1995 Commercial Life Insurance Piscataway, NJ
Claims Examiner
Negotiated with Beneficiaries for unsettled or disputed Accidental Death or Disability Claims
Investigated disability, accidental and life insurance claims
Worked with Equifax and International Claims Specialists on investigating and setting up independent medical exams
Created and developed a database that enhanced the payment of life and disability claims
Due to the efficiency of this database I received a SPOT Award and bonus
Education
2002 County College of Morris
Humanities/Liberal Arts
1986 Dover Business College
Associates in Fashion Retail Management
1984-1986 County College of Morris
Nursing Program
Other Required:
Computer Literate: intermediate to advance use of Microsoft Office Suite (Word, Outlook, Excel and PowerPoint (optional).
Proficient in Amerigroup/Anthem systems: Care Compass, MACESS, FACETS and previous systems used at Amerigroup-AMYSIS and Case trackers
Skills:
Excellent verbal and written communication skills
Strong decision maker
Ability to interact with all relevant components of the health care system
Ability to provide services that deal with individuals with a broad spectrum of needs
Self-starter with the ability to handle multiple projects at one time.
High energy individual
Appreciative of cultural diversity and sensitivity towards others
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