Project Manager Real Estate
Resume:
KAREN E.
ROURKE
*********@*****.***
Riverview, FL 33579
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Extensive knowledge of medical insurance, claims, benefits and authorizations. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
PROFESSIONAL SUMMARY
Orthopaedic Medical Group of Tampa Bay - R Representative 08/2020 - Current
Neumann Real Estate, William Pitt Sotheby's International - Real Estate Sales Agent
02/2011 - 05/2020
Servpro of - Project Manager Coordinator
07/2015 - 11/2019
WORK HISTORY
• ERA Payment Posting for all Insurance receivables. Medicare, Medicare Advantage Plans, Medicaid, Commercial and WC Insurance claim follow up.
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Working knowledge of federal and state insurance guidelines required for accuracy with approximately 95% success
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Creating and filing appeals, submitting corrected claims along with correcting claims via SPOT & CGS.
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Confirming eligibility, review and submitted medical records, reviewing EOB's, confirming accuracy of payment posting, submitting claims to secondary payers.
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Communicated with clients to understand property needs and preferences.
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Negotiated between buyers and sellers of properties with efficiency and transparency to maximize profits and maintain satisfaction of clients.
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Wrote listings detailing and professionally highlighting property features to increase sales chances.
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Educated clients on sales and buying processes and advised buyers on making decisions.
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Homeowner's insurance claim management, scheduling, billing and claim submission.
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Working knowledge of homeowners insurance policies claim submission with 100% accuracy required for payment.
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Assisting assigned Project Manager with all aspects of individual home remediation and re-construction jobs including scheduling, insurance loss approval and claim submission.
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Maintaining and managing requirements as outlined by various insurance companies for each individual home insurance claim.
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SKILLS
Proficient with ECW,
Waystar/Zirmed, CMS/FFS
Medicare (SPOT AND CGS) and
Medicare HIQA/HIQH
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Availity, Navinet, CT and FL
Medicaid, UHC & Wellcare Portals
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Proficient with Microsoft Word,
Excel, Power Point, Outlook,
Provider Flow, Empower,
Microsoft Teams
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• ICD-10 and CPT Coding
Medical Claims Dispute
Resolution
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• Medical Benefits
• Medical Terminology
• Health Insurance Terminology
Physician/Surgical Billing and
claims
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• Homecare Billing and claims
• Hospice billing and claims
• Hospice NOE submissions
Norwalk High School
Norwalk, CT
High School Diploma
EDUCATION
Constellation Home Health Care - Billing Representative 11/2011 - 07/2015
Keller Williams Realty
06/2006 - 02/2011
Tender Loving Care Home Health Care - Senior Billing Coordinator 07/2000 - 06/2006
Insurance requirements and parameters differed for each job. PPS Home Health & Hospice clean claim submittal, follow up appeals to Medicare, Medicaid, BCBS, Aetna, Cigna, Humana.
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Established & maintained new Hospice billing division within billing dept including Hospice NOE & Revocation submissions with 100% accuracy for claim NOE and claim submissions to Medicare.
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• 500,000 monthly clean claim submissions to Medicare Worked closely with Intake department reviewing insurance status and potential conflicts with other home care & hospice providers for all new patients.
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Communicated with clients to understand property needs and preferences.
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Negotiated between buyers and sellers of properties with efficiency and transparency to maximize profits and maintain satisfaction of clients.
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Wrote listings detailing and professionally highlighting property features to increase sales chances.
•
Educated clients on sales and buying processes and advised buyers on making decisions.
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• PPS Home Care claim submissions to Medicare
• Clean claim submission commercial insurance and Medicaid Working knowledge of federal, state and corporate guidelines required for accuracy with approximately 95% success of initial submissions
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Maintained current episodic Medicare billing while reduced outstanding account receivables by 60%
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Researched and resolved outstanding T19 account receivables of 1.8 million dollars, collecting, as part of a team effort, 12+ million dollars
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Provided area business manager with regular reports on status of accounts
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Intake specialist - Confirmed health insurance eligibility for all potential patients
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Cross trained in Oasis/DRG data entry, Payroll Management and Home Care Scheduling
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• Floated out to multiple offices on as needed basis.
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