Human Resources Medical Billing
Resume:
Clara Thompson
San Marcos, TX 78666
**************@*****.***
Cover
Page 1
My background is primarily in the California worker’s compensation system, for over 20 years. My initial focus was working in medical billing and collection of services, including litigation and negotiations of medical liens. I owned and operated a billing service and have managed a muti-specialty medical billing and collections department, for 7 years. I moved onto working for a defense law firm in lien litigation and case management for expedient settlements, with practical experience outside and inside the courtroom. Legal billable hours quota was 200 hours per month. I am currently working as a worker’s compensation claims adjuster. I am bilingual and fluent in speaking, reading, and writing Spanish. My combined professional experience including worker’s compensation litigation also incorporates, team building, human resource functions, publishing jobs, conducting interviews, onboarding, training, periodic staff evaluation, exit interviews, credentialing, vendors, contracts, assisting in the opening of a second office, surgical scheduling for orthopedic surgeons & multiple outpatient procedures. Medical coding, billing, collections, appeals, bill review, with an emphasis on maximizing reimbursement and decreasing account average DSO from 180 days to an average 45 days out. I managed a staff of 8 billers and collectors, between two medical offices. I recently relocated to San Marcos, Texas from California, and I am looking to set roots in a company that appreciates a person like myself, who, likes to work in a diversified environment. I am really interested in continuing my career in management of a medical office, medical billing & collections department. I am also interested in human resources, operations & project management. I possess a fair amount of cross training in these areas, and I am very driven and always open to learning and taking on new challenges. I am not a paper pusher and prefer to be involved in every aspect of my work. I am used to wearing many hats and I can work independently or leading a team. Educational Background:
Woodrow Wilson High School, Long Beach, California General Education -1998 Cerritos College, Cerritos, California Associate of Arts - 2000 Cerritos College, Cerritos, California Medical Billing/Coding Certificate - 2001 Worker’s Compensation Adjuster’ License Texas License – 2021 Work Comp Central – Labor Law/Regulations Worker’s Comp Certifications 2008-2019 Expertise/Specialties include:
Microsoft Office Applications MTUS, ACOEM, AMA Guidelines Electronic Medical Records Electronic EAMS Filing (legal documents) Multiple Knowledge of Software and Applications Human Resources, Labor Law Knowledge of Workers Compensations Codes & Regulations Litigation/Bill Review Knowledge of Multiple Disciplines in Medical Practices Medical terminology/Coding Knowledge of CPT coding, ICD-9, ICD-10 Accounting Programs Professional References:
Benjamin Mason 480-***-**** Morley Mason, PLC – Professional Reference Rosie Santos 323-***-**** Bell Community Medical Group - Professional Reference Esteban Ramirez 310-***-**** Worker’s Compensation Hearing Rep - Professional Reference Ana Sinsun 714-***-**** Friend 30 years – Personal Reference Clara Thompson
229 Split Rail Drive
San Marcos, TX 78666
**************@*****.***
Resume
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CAREER HISTORY
Nationwide 03/2022 – Present
Remote (WFH) – California Team
Worker’s Compensation Claims Adjuster II
Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management & negotiation.
Investigate assigned claims, including those of a more complex litigated nature
Determine coverage, compensability, potential for subrogation recovery, and special investigations
Ensure timely denial or payment of benefits in accordance with jurisdictional requirements
Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure
Negotiate claims settlements within authority
Works with nurse case manager on complex medical claims, to expedite return to work strategies
Maintain a working knowledge of California jurisdictional requirements and applicable case law
Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
Provide a high degree of customer service to clients, face to face (zoom) interactions during claim reviews and meetings
Authorize treatment based on the practiced protocols
Initiate & coordinate QME Evaluations in accordance with applicable state statutes Morley Mason, PLC 07/2017 – 11/2020
Worker’s Compensation Defense Firm
2600 W Geronimo Pl., Ste 100
Chandler, AZ 85224
Hearing Representative
Responsibilities included, representing insurance companies and third-party administrators at the WCAB for conferences and trials
Prepare a case analysis and set parameters for reserves
Prepare a plan of action with expected outcome of litigation, depending on the financial exposure of the individual case
Litigate the case informally and in court
Negotiate all aspects of the case, within authority parameters
Audit lien claimants and raise affirmative defenses regarding the treatment rendered, within reasonableness necessity, medical adoption of services, medical provider network eligibility, utilization review and independent medical review
Exercise legal arguments per workers compensation labor codes and California regulations
Review the medical fee schedules and request justification of reimbursement
Prepare cases for trials by submitting evidence, listing arguments, exhibits, listing witnesses and preparing pre-trial conference statements
Prepare and coordinate appeals, objections, rebuttals and OMFS review for preparation for settlement negotiations
Meet legal billing quota of 200 hours per month
Clara Thompson
229 Split Rail Drive
San Marcos, TX 78666
**************@*****.***
Resume
Page 3
Magnum Opus Management Services
Detox Center, Rehabilitation and Sober living 07/2015 – 07/2017 2973 Harbor Blvd, Ste 305
Costa Mesa, CA 92626
Operations Manager/Human Resources
Assisted the management company with coordination of acquiring and establishing detox and outpatient facilities throughout Southern California
Duties included managing the State and City credentialing process for the facilities. Set up utilities and essential equipment per facility, such as telemedicine, medicine dispensary and facility essentials for resident’s use
Managed credentialing of medical providers and submit/manage prefer provider health insurance contracts
Worked with private platforms for staffing services of clinical and ancillary staff, as needed
Prepared recruitment advertisements for staff, managed onboarding functions, including reference and background checks
Managed all aspects of benefits and compensation, such as payroll, paid time off, sick leave, extended and emergency time off (FMLA) per state guidelines and regulation
Coordinated employee orientations and training
Managed employee reward system and coordinated employee appreciation functions to boost morale
Perform periodic reviews and exit interviews with or without management staff
Assisted managers in overseeing the intake, medical documentation, authorization process
Managed the billing and collections department
Bell Community Medical Group 02/2008 – 07/2015
Multispecialty Worker’s Compensation Clinic
4001 E Florence Avenue, Bell, CA 90201
Billing/Collection Supervisor and Hearing Representative
Managed and coordinated the billing & collection department. Managed a staff of 8 hearing representatives
Coordination of billing, coding and collections to Medicare, Private Health Insurance carriers and Worker Compensation carriers
Managed A/R, payment posting and reconciliation
Performed Human Resources functions, such as recruitment, onboarding, training, managing, implement reward system, coordinate office celebrations to uplift morale. Managed payroll and time off request
Coordinated authorizations, surgery scheduling, physician credentialing
Planned and attended marketing events and large marketing conventions
Represented physician liens at the WCAB at conferences and trials, write appeals, rebuttals and OMFS review preparation for settlement negotiations with claim adjusters and defense attorneys
Preparation of cases for litigation and coordination of hearing representatives, including filing of appropriate legal documentation with the WCAB. Maintaining a calendar system, proper documentation of minutes and follow-up with legal procedure for collection efforts
Maintain accounting and reporting of P&L, A/R and forecast to track company growth
Work with programmers in developing and implementing use of new systems, programming reports, electronic data collection and e-filing. Market area research for new business development Clara Thompson
229 Split Rail Drive
San Marcos, TX 78666
**************@*****.***
Resume
Page 4
Accubilling Services (Owner) 07/2003 – 04/2008
16428 Sylvanwood Avenue, Norwalk, CA 90650
Medical Billing and Collection Service
Billing/Collection and Hearing Representative
Owned and operated a full-service multi-specialty medical billing and collection agency
Responsibilities included: medical billing, coding, payment posting and reconciliation
Explanation of benefit appeals or corrections. Representing physician accounts in court to negotiate Worker Compensation liens, appeals, rebuttals and claim review preparation for settlement negotiations with claim adjusters and defense attorneys at lien conferences and trials.
Review per, OMFS (fee schedule), CPT, HCPCS, and ICD-9 coding
Prepared month end functions and provided monthly A/R reports to all my clients, which included, Orthopedic, Chiropractic, Internal Medicine, Pain Medicine, General Medicine, Cardiology, Plastic Surgery, Home Health and Hospice, Long Term Care Facility, Professional & Ambulatory Surgical Center claims, In-Patient and Out-Patient Hospital Claims.
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