Joan Winfree

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

West Chicago, IL *0185

Cell Phone: 331-***-****

E-mail: adhdjr@r.postjobfree.com

Objective

I am currently seeking to advance in the Healthcare network I have previous skills with the many applications utilized to reprice claims as well as to interpret Provider contracts. I believe my current skills at being a Resolution Specialist would benefit your department

Experience

[2008 – Present]

Service Operations - Resolution Specialist – Multiplan Inc.

• Review and resolve Practitioner and Facility claims/complaints and Client explanation of benefits to determine whether the allowed payment was appropriate.

• Complete practitioner and hospital claim resolution within the department guidelines. Communicate consistently and accurately with Practitioners and Hospitals until inquiry/case is resolved including conference calls when necessary.

• Research multiple databases for similar issues and reviews issues with internal experts as necessary. Work closely with internal staff to identify root cause and resolution.

• I was the dedicated Provider representative for four hospital and was able to handle the conflicts efficiently and effectively.

• I have also received the respect and confidence of my Team Lead and Senior that I can accomplish my job efficiently with no supervision. I have received two Shining Star awards for my work.

[2006 – 2008]

Addison Search Reimbursement/Collector (RMS Lifeline) Addison, IL

• Medicare Collection Specialist: Reprice claims using AMA medical/data resources, and client's product & services for effective claim appeal results.

• Perform Coordination of Benefits.

• Research local coverage determination and verify insurance coverage. Audit claims and correspond with Providers, PPO, HMO and 80/20 Insurance companies to resolve claim issues.

• Maintain turnaround time for book of business.

Education

• [2003 – 2004] North Florida Institute Jacksonville, FL Health Information Technologist (NCCT

Certification).

• [1996 – 1996] Purdue Calumet College Hammond, IN Administrative Assistant Unit Coordinator Certification Communication

I have also received the respect and confidence of my Team Lead and Senior that I can accomplish my job efficiently with no supervision. I have received two Shining Star awards for my work.

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