Medical Manager

EXPERIENCE

BUSINESS OPERATIVE ANALYST II, GOVERNMENT UNIT, AMERIGROUP, TAMPA, FL 2014-2020

Project manager for overpayment recoveries on UB04 and 1500 claims including the research, development and resolution of data anomalies in claim projects pertaining to multiple regions with the United States

Ran sequel queries utilizing SQL to capture overpayment data

Wrote high level business process and legal requirements for projects

Communicated project status with stakeholders

Managed oracle and data platforms

Designed efficient IT systems to meet business and technology needs

Coordinated with developers to build and implement technology solutions

Analytical and financial modeling for operations

SR ADJUDICATOR, BUSINESS UNIT TAMPA, FL 2012-2014

Unit lead for medical and dental clinical records review for auto accident, workman comp and liability claims

Implemented system testing, root causes, macros and deployments of new applications

Responsible for CMS audits

Trainer to offsite teams in Mexico

RETROSPECTIVE SR CLAIMS ADJUSTER, LEGAL CLAIMS UNIT TAMPA, FL 2010-2012

Managed complex medical and dental workman’s’ compensation, liability, and auto accident claims on behalf of the insurance companies for retrospective reviews

Investigated pertinent records for cases including full medical and dental and worked with private investigators to determine fraud

Scheduled IME (independent medical evaluation) and determined PIR (permanent impairment ratings) to finalize monetary value post-accident injuries

SURGICAL TECHNOLOGIST, TAMPA, FL — 2006-2009

Assisted surgeon with surgeries and treatment

Xray technician including CT and Pano

Pre- and post-surgery coordination including sedation

Responsible for the processing of medical and dental claims related to surgeries

EDUCATION

CENTRAL FLORIDA, FL - SCIENCE 2006

BOSTON UNIVERSITY, MA- PARALEGAL 2016

SNHU, NH- LOGISTICS 2021

CERTIFICATIONS

ALL LINES ADJUSTER 620-STATE OF FLORIDA

CERTIFIED PARALEGAL- USA

CERTIFIED TECHNOLOGIST-STATE OF FLORIDA

CERTIFIED EFDA-STATE OF FLORIDA

CERTIFIED XRAY TECH-STATE OF FLORIDA

PMP PRACTIONER- 2020

15 years of business and project management experience

Over 10 years of UB04 and 1500 claims processing knowledge

CPT/ADA billing and coding expert

Extensive medical and dental clinical knowledge

Expert in interpreting legal verbiage and contracts

Expert in data analysis, automation, and statistical analysis

Proficient in SharePoint, Microsoft Excel, PowerPoint, Word, and Access along with business applications and software oracle, SQL, facets, Macess, Claims 2.0, WGS, and Platforms and claims automation through Avility

NACOLE BRIDGES

2350 Cypress Pond Road Unit 805 Palm Harbor, FL 813-***-****

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