Enrollment Specialist Claims Examiner
Resume:
Lisa S. Obiete
414-***-**** **********@*****.***
CAREER GOAL
To obtain a challenging leadership role in which I can apply my knowledge of accounting and auditing theories, practices and principles. To utilize my creative problem solving and analytical skills merged with enthusiasm and talent for learning to fully develop professional skills.
EDUCATION/TRAINING
Concordia University Wisconsin, Mequon, WI May 2012- May 2017
MBA Program-Healthcare Administration
Concordia University Wisconsin, Mequon, WI August 2006-December 2011
Bachelors of Science Major: Business Management, Minor: Healthcare Administration
TECHNICAL SKILLS
Microsoft Excel, Word, Outlook, PowerPoint, Peoplesoft, Microsoft Dynamics
PROFESSIONAL EXPERIENCE
United Healthcare
September 2020-Present
Claims Examiner
●Analyze and process a variety health claim forms; UB-04, CMS-1500 or ADA
● Follow claims adjudication process to assure that all claims are adjudicated in accordance with CMS rules and regulations
●Review Medicare, Medicaid and Commercial services for appropriateness of charges
● Authorize claim payments within established limits
● Process refunds and letters of dual coverage (when applicable);
●Identify process improvement opportunities within the claim department and recommend system
Kforce Professional Staffing
Froedtert Hospital September 2019-Febuary 2020
Cash Posting Generalist (Temporary)
●Posted patient/guarantor and insurance payments and adjustments accurately and timely per posting policies and procedures.
●Interpreted, analyzed, and processed daily cash and remittance advices received to determine the appropriate contractual allowances, discounts, other allowances, transaction codes, patient account transfers.
●Audited credit balance accounts for possible refund or transfer to other outstanding balance accounts.
●Served as backup when other team members were out.
Milwaukee Rescue Mission
July 2019- September 2020
Case Manager
●Acclimate residents to the facility through the Mission’s initial intake and orientation process
●Communicate behavioral actions through the incident reporting process
●Conduct room inspections, document and communicate appropriately to respective management and provide feedback to resident and case management
●Conduct direct observation drug and alcohol screenings, including breathalyzer and urine tests.
●Ensure physical comfort and safety of the residents as well as meet their needs for food, shelter, clothing and personal care
●Maintain effective communication between staff members and Case Managers by means of various communication vehicles including matrix log, incident, written and verbal reports
●Monitor and assess participant progress towards identified goals
●Maintain accurate and up-to-date case records; document participant meetings and progress to ensure program compliance and adherence to best practice standards
Brookdale Senior Living
Cash Application Analyst August 2017-March 2019
●Monitored and gathered Medicare remittance advice or lock box deposits for manual or electronic postings.
●Reconciled individual payer transmissions or lock box deposits in a timely and accurate manner
●Worked exception and error listings associated with maintaining and processing the facilities receivables such as, overpayments, refunds, misapplied, unapplied payments and charges, and retuned checks
●Recognized and reported cash receipt trends, e.g. fraud, theft, etc. to Treasury Operations Supervisor
Brookdale Senior Living August 2014-August 2017
Revenue Cycle Analyst
●Provided quality customer service in a high-volume, fast-paced, multi-channel contact center using automated call distribution software while accurately processing and documenting call transactions via the designated tracking software.
●Assisted in training community associates as relates Accounts Receivable procedures and functionality available in multiple proprietary systems.
●Identified potential customer account issues through review of daily, weekly, and monthly generated reports and queries.
●Researched and resolved potential billing errors through regular customer account audits to ensure billing accuracy and maintain a high level of customer satisfaction.
●Continuously evaluated and identified opportunities to drive process improvements that positively impact the customers’ experience.
Novitas Solutions, Inc. September 2012-June 2014
Provider Auditor
●Performed limited or full audits of cost reports for hospitals, skilled nursing facilities, renal dialysis clinics, federally qualified health centers or rural health clinics that receive Medicare reimbursement
●Performed tentative settlements on submitted cost reports or analyze the cost report to update the health care facility’s interim payment rate amount and determine any potential adjustment to payments
●Generated and customizes all required internal and external correspondence and checklists to facilitate implementation of, and evidence of, completion of the audits
●Coordinated with the Senior and/or In-Charge auditor in performing hospital audits. Performs post audit activities including follow-up with provider representatives
●Was responsible for a number of special project, as deemed necessary, including continuous improvement projects and assisting team manager with other functions
●Attended entrance and exit conferences and advises health care providers on Medicare policy questions as needed
Employee Benefits Consultants, Inc June 2006- September 2012
Enrollment Specialist
●Timely responded to Client Manager and Client Executive requests for information or help
●Handle incoming calls from assigned clients regarding benefit questions, claim issues, eligibility, billing and other support issues
●Marketing of cases for existing business renewals and new business; marketing function include gathering census & experience information, plan designs, rates and previous carrier information
●Worked with carriers to ensure the timely processing of case submissions; work with carriers to ensure ID cards are received by the client in a timely fashion
●Supported Client Manager with enrollment materials, information and presentations for meetings with clients
●Provided backup support to Client Manager when not in the office
●Proof proposals and benefit summaries for other team members
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