Kerry M. Hufland

** *** *** *****

Albany, NY ***05

adq936@r.postjobfree.com

518-***-****

Extensive knowledge of medical insurance, medical terminology, customer service, eligibility, billing and claim review with local and national carriers. Exceptional customer service with obtaining and verifying insurance authorizations for patients, enabling the office to more quickly file claims and receive payment. In-depth understanding of MVP, CDPHP, EBCBS, Medicare, and Medicaid websites for collecting/verifying patient information. Including filing claims VIA e-paces website and obtaining Prior Authorizations. Highly skilled in the Medicare Appeals Process. I have taken part in multiple ALJ hearing for appeals and have been successful at obtaining payment. Ability to work as part of a team or independently. Ability to work in a call center atmosphere. SIGNATURE SKILLS S • Excellent customer service skills, including verbal and written communication, as well as strong listening skills • Ability to quickly understand and interpret patient complaints and work to resolve them in a timely fashion. Strong conflict resolution skills • Skilled with Microsoft Office applications (Word and Excel) • Exceptional filing and multi-tasking skills • Highest level of confidentiality when handling patient paperwork and diagnosis information following all HIPAA requirements • Extensive customer-relations background • Working knowledge of all major insurance plans such as Medicare, Medicaid, MVP, CDPHP, and many others • Robust knowledge and understanding of Zirmed, E-Paces/EmedNY, UHC, MVP, CDPHP, and EBCBS Websites for eligibility, billing, and claims review • Extensive knowledge of pharmacy providers. Such as Caremark, Silver Scripts and Express Scripts. • Ability to provide callers with correct benefit information, including but not limited to Copays, OOP expenses, and explaining the Coverage GAP (donut Hole) for Medicare.

• Working knowledge of all lines of business guidelines including, but not limited to HMO, PPO, and UBI. • Working knowledge of Workman's Compensation, and No Fault Laws.

Work Experience

Billing Analyst/Care Coordination St. Peter's Health Partners - Albany, NY

September 2018 to Present

Requesting clinicals for patient who are admitted into our facility

Entering Authorization numbers into EPIC system

Review and update reports from insurance companies verifying if their members are still hospitalized

Review claims for accuracy as far as coding, and reimbursement rates.

Entering charges/CPT codes with modifiers for sleep studies.

Obtaining Prior Approvals from insurance company

Answering phones

Check in/Check out

Intake Specialist Martin Harding & Mazzotti LLP

September 2016 to September 2018

Harding and Mazzotti New Client Acquisition

• Answer Multiline Phone

• Transferred calls to correct department

• Assisting callers with questions regarding legal representation.

• Collecting detailed information regarding Motor Vehicle Accidents, Workmen's Compensation, and Medical Malpractice.

• Scanning Medical Records into Laser Fiche

Customer Service Representative

Empire Blue Cross and Blue Shield

February 2015 to September 2016

• Answering phone in a Call Center Atmosphere

• Advising members of Medical and Pharmacy benefits

• Accurate documentation of all calls received

• Advising members of appeals/grievance processes

• Advising members claim status'

• Maintaining and enforcing HIPAA regulations

• Follow up on calls from members, who may have ongoing claims issues.

• Being a member advocate for some of our special needs’ members.

• Calling out to billing departments in order to help our members understand a bill they have received.

Medicare Inside Sales Call Center CDPHP- Medicare Call Center

May 2014 to October 2014

• Educated prospective and current members in the various Medicare Advantage Plans we offer. Certified in AHIP.

• Advised of criteria that need to be met in order to qualify for Advantage Plans.

• Advised of coverage that is available under these plans. Located participating providers’ and checked Medicare Formulary for prescription medications. Provider Services Call Center

• Answered phone calls from providers regarding member's eligibility for all lines of business.

• Utilized Provider Facets application to determine in or Out of Network providers.

• Advised providers of specific benefit information they requested utilizing CDPHP.com/Benefit Viewer.

• Advised of copayments and/or coinsurances. Educated providers on the Prior Approval/Prior Notification process. NYSOH Exchange

• Customer Service Representative assisting callers on the Health Care Exchange.

• Able to advise of rate information, and assistance that maybe available to members.

• Assisting callers with Out of Pocket costs they may have with the new insurance changes

• Rate Calculation

Senior Office Administrator Hanger Clinic

May 2008 to December 2013

• Answer and direct multiple phone lines

• Post payments to patient accounts

• Admission and discharge of patients

• Obtain and verify insurance and authorizations for patients

• Handle Medicare Reconsideration, redeterminations requests, and A.L.J. hearings as needed. Including, RAC audit and Pre-Payment reviews. Including understanding of DRG requirements

• Contact insurance companies regarding correct reimbursements

• Financial Counseling for patients that are in need of financial help

• Maintain Accounts Receivable in line with company standards• Follow up on claims to verify receipt through Electronic Submission

• Payroll

• Filing

• Maintain patient records for per Medicare regulations.

• Contacting insurance companies regarding denials

Education

GED

Colonie Central High School - Albany, NY 1989

Skills

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Medical terminology

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