BEATA WRIGHT

973-***-**** adoqk7@r.postjobfree.com linkedin.com/in/beata-wright-74ab4154/ Parsippany NJ, 07054 Licensed PIP Claim Examiner having more than decade experience in the insurance industry, bringing key competencies within the claims examining and adjustment fields. Spearheaded identification, investigation, evaluation, and adjuration of claims by accurately obtaining and utilizing critical information. Demonstrated ability to direct and complete multiple projects while meeting strict deadlines and compliance requirements. Knowledge of workers compensation rules and regulations. Skilled and experienced in bill review, and bill coding. Possess strong written and oral communications skills. PROFESSIONAL SKILLS

● Anesthesia/Pain Management

● Bill Review

● Claims/Personal Injury Protection

● Medical Records/Invoicing

● Case Management

● Financial/Records Reconciliation

● Accounts Receivable (AR)

● Medical Billing/Payments

● Record Maintenance

● Financial Management

● Microsoft Office Suite

● Coding/Billing Coding

● Organizational Skills

● Relationship Management

● Leadership Skills

PROFESSIONAL EXPERIENCE

National General Insurance Company Greater NYC Metropolitan & NJ Area PIP Claim Examiner 02/2019 – Present

● Provide problem resolution expertise in matters of errors and reconciliation.

● Preserve confidentiality of all claim files, claim reports and claim-related issues.

● Ensure claim files are properly documented and claims coding is correct.

● Handle Personal Injury Protection claims from inception through closure in compliance with Regulation 68.

● Review PIP coverage, investigate and analyze injuries to make as to coverage and course of action.

● Utilize Peer Reviews and Independent Medical Examinations to ensure medical necessity of treatments and procedures rendered.

● Evaluate claims for potential fraud indicators/work closely with SIU.

● Review and issue Lost Wages and reimbursement for other necessary medical expenses.

● Maintain communication with all involved parties (providers, attorneys and employers) in timely and professional manner.

● Assist with litigations and settlement procedures.

● Follow proper client and state regulations to ensure compliance with appropriate guidelines NJ PLIGA Greater NYC Metropolitan & NJ Area

Medical Bill Review & Coding Coordinator 09/2017 – 02/2019

● Updated and recorded confidential information including address changes, billing accounts at customer's request.

● Utilized coding guidelines, bundling/unbundling codes, contract rates, fee schedules, and UCR to process and pay/deny bills.

● Delivered significantly lower amount of outstanding bills by implementing specific business initiatives.

● Protected company/patient from potential fraud and overbilling through investigations and close monitoring of suspicious providers.

LICENSED PERSONAL INJURY PROTECTION (PIP) CLAIM ADJUSTER DRIVING SUCCESS THROUGH TEAM LEADERSHIP, RELATIONSHIP DEVELOPMENT AND CONTINUOUS IMPROVEMENT BEATA WRIGHT Page 2

Emergency Medical Associates Greater NYC Metropolitan & NJ Area Worker’s Compensation and PIP Analyst 07/2012 – 07/2017

● Performed day-to-day operations of analyst such as research/address denials and appeals and identify trends and changes in state policies and regulations.

● Supported Microsoft Dynamics GP including Integrations, implementations, and maintenance of 3rd party products

● Oversaw PIP and Workers’ Comp bills for five states.

● Secured “higher tier reimbursement for service rendered out of network by leveraging billing negotiation techniques.

● Coordinated with adjusters, attorneys, and medical providers to ensure proper reimbursement for services rendered.

One Call Medical Finance Department Greater NYC Metropolitan & NJ Area Bill Review Specialist 07/2011 – 06/2012

● Executed administrative activities which included managing projects, composing letters, and compiling reports.

● Prepared weekly/monthly reconciliation reports of cash flow and claims.

● Analyzed bills for medical provider for entire provider network in USA.

● Gained and implemented knowledge of different PPO networks, Fee Schedule/UCR states and various regulations.

● Solved billing issues by utilizing proper coding and assessment of incorrectly paid claims. Urology Specialty Care and Surgicare Associates Greater NYC Metropolitan & NJ Area Billing Coding and Collection Specialist 02/2004 – 09/2009

● Maintained all medical claims for doctor’s office and facility.

● Managed personnel resolved issues and inconsistencies and utilized appropriate corrective procedures.

● Administered duties of posting charges, handled cash, and compiled monthly AR reports.

● Supervised billing team consisting of eight team members.

● Served as liaison between service providers and insurance companies. EDUCATION & LICENSES

Bachelor's Degree in Physical Therapy College of Medicine, Krakow, Poland Certificate in Medical Billing and Coding Berdan Institute, Totowa, NJ Active PIP Claim Examiner License

LANGUAGES

English – Fluent

Polish - Fluent

Contact this candidate