Healthcare Operations & Claims Analyst Leader
Resume:
Rodney Turman
***** **** ***** ** ****** Queen Creek, AZ 85142 ******.**@*****.*** 480-***-****
ealthcare operations analyst and claims adjudication, audits, team lead, and C.S.R.
Research & Adjustments Claims Analyst III Grievance Coordinator
PROFESSIONAL EXPERIENCE
11/22- 05/25 Morgan Stanley – Client Service Associate- Provided multi-platform support via full-service retail,
and Self-directed accounts and provided stock plan initiatives and tailored financial solutions to help our
clients reach their personal financial goals.
03/22-11/22 Early Warning Systems-Consumer Services Analyst II- Received Inbound calls from
customers/consumers, provided technical support, fraud detection, claims and general inquiry support
for zelle end users.
09/21- 01/22 Aijilon Staffing – Accounts Receivable Lead-FKP-
Responsible for all billing and collections activities to ensure maximum efficiency for Florida kidney
physicians group accounts. Implemented plans to ensure that charges are billed appropriately, and
reimbursements are resubmitted to payers until maximum allowed payment is received. Run regular
A/R aging reports, maintain logs, ensure A/R balances are collected and resolved, and review billing
error reports while providing root cause analysis and solutions. Monitor, analyze and manage changes
related to billing regulations/requirements, and communicate the impact of the changes to our clients.
07/21-09/21 Cornerstone Staffing - Responsible for all collections activities to ensure maximum auto loan
account maintenance and payments are allocated for 60-90-120-day accounts.
12/17–02/21 Apria Healthcare Inc Customer Quality Specialist- Kaiser Permanante Team –Responsible for
qualifying equipment orders for members received from referral request for home equipment and services. Provides information on equipment supplies and services. Responsible for identifying the correct insurance, and clinical documentation is present along with demonstrating professional etiquette and courtesy when interfacing with customers. Initiate patient contacts to: advise them of the order placed on their behalf and to confirm all patient demographic information; and communicate any financial responsibilities and/or additional information necessary for processing the order received; Process information received from intake/service personnel. Ensures proper selection of information online to ensure timely delivery and appropriate revenue recognition for orders. Demonstrates professional etiquette and courtesy when interfacing with customers, resolves patient/customer complaints by identifying problems and coordinating appropriate corrective action.
11/10 – 11/17 UnitedHealth Group
Clinical Admin. Coordinator: Receive Care Coordination notification cases for non-clinical
assessments of outpatient procedures, worked with Tricare, home health, DME, transition of care,
Site of Service and sleep study cases. Determined benefit coverage issues based on group
contracts /document and triage cases for
additional
Clinical Coverage Review to ensure all potential member needs are identified, along with assured all
authorizations were processed within DOL time frames with appropriate ICD-9 and CPT coding usage
and Communicated to providers and members the benefit determination outcome within DOL time
frames.
01/08 – 12/09 Canyon State Academy
Coach Counselor: To provide counseling and cognitive behavioral change by using proven therapeutic methods for problematic teens and a group home living environment
07/06-05/07 Schaller Anderson
Claims Analyst: To accurately adjudicate UB-92 and HCFA-1500 clean claim submission via the Qmacs and Qnxt claims processing system, with a financial accuracy of 99% or above, assisted when needed for multiple Plans, (ex: CHOC, DPCI, MHIP) along with call tracking for MCRP plans and provided upgrade suggestions to the operations/ I.T dept. staff when “S.A” implemented the new 3.2 QNXT platform system.
08/05- 06/06 Ledgent Staffing Firm Various Assignments:
A/P- Assistant: @ First American Title sorted payable invoices from five escrow title offices based in Nevada, New Mexico, Oklahoma, Houston Texas, and Arizona noted the GL-coding and scanned/downloaded documentation via Epayables wintergrate program and attached scanned invoices and backup to the appropriate check in the wintergrate payables system.
A/R CSR: @ Swift Transportations
Performed all activities in the accounts receivable function, along with the management of account collection activities such as sending open invoices, auditing and follow-up inquiries with past due accounts. Referred accounts for credit adjustments and maintained accurate records. Stream lined new methods and procedures of accounts receivable functions to improve efficiency.
Jr. Accounting Tech: @ Bureau of Indian Affairs
Daily tasks included researching account payables by clients, forwarding correspondence collection letters opening new client debt receipts. Updating client records and tracking all information via B.I.A billing system and Excel.
08/04-05/05 Health Choice Arizona Claims Processor:
Grievance Coordinator: Adjudicated facility and medical claims according to contractual guidelines. Determined and/or verified accurate coordination of benefits, opened provider grievances received via phone and certified mail. Interviewed appropriate department heads and experts on the subject matter. Compiled pertinent data, and performed trend analysis when applicable. Composed decisive action correspondence letters for providers.
04/04-08/04 Prime Staff H.R. Consulting
Claims Analyst: @ Maricopa Medical Center
Research & Adjustment Rep@ Schaeller Anderson
To correctly adjust previously processed UB-92 and HCFA-1500 claim payments, in the Oasis, and Qmacs claims system paying retroactive claims from previous years which were Denied or pended claims, for organizational reasons, assuring contractual payments, were valid in accordance to current contracts with AHCCCS, and Medicare guidelines. Also adjudicated clean claim submissions within time limitations.
05/03- 04/04 NCO Financial
Patient Accounts Receivables: Verify patient demographics, and their insurance coverage benefits and insurance carriers. Handled follow-up and Investigation of payment sources such as workmen's compensation auto insurance, etc. Reviewed payment history-initiated billing and payment collections from guarantors, third party, or joint billing guarantors and patients according to policy guidelines. 07/02- 01/03 Forum Temporary Services
Accounts Receivable/Payable: @ N.Y.U. Rad. billing dept.
Senior Claims Analyst: @ HIP
Adjudicated medical claims, claims billing, and account receivable. Verified accurate member health coverage, and CPT / ICD-9 coding, handled written and electronic correspondence and assured cob guidelines was adhered to prior to final payments of medical and hospital claims.
05/01- 06/02 Heritage New York Medical
Claims Analyst: Approved, determined and resolved medical claims submitted by various doctors and hospitals, and attached pre-authorizations, when applicable for HMO, POS and PPO indemnity claims according to plan guidelines.
Staffing Remedies Temp/Perm
Claims Analyst: Placement at above company.
Part-time
10/0- 02/01 CVS Pharmacy’s
Shift Supervisor/Asst. manager: Managed a staff of 4 to 8 employees.
Maintained store inventory, resolved irate customer issues, as well as cashier inventory and bank depository drop. Compiled In ran cash, summary and personnel time management reports.
06/09- 09/00 CIGNA Healthcare
Customer Service Rep: - Provided health plan account eligibility information to members, providers, policyholders and account administrators as well as all related policies and procedures of their plan.
04/97- 05/99 Blue Cross Blue Shield Referral Specialist:
Managed Care Associate: provided pre-certification to facilities and providers for elective outpatient / in-patient ambulatory surgical services, along with daily gastro, and maternal elective service authorizations via telephone and fax referrals also directed emergency authorization request to the appropriate RNA staff member. Also processed HCFA 1500 and UB-92 HMO claims in accordance to plan guidelines.
07/90- 02/97 Group Health Incorporated
Responsibilities: Senior Claims Approver - Adjusted and analyzed medical claims and performed all duties related to accurate coding, of CPT and ICD-9 coding of medical and hospital PPO claims to assure accuracy of claims payment.
EDUCATION:
Attended (University of Phoenix).
Attended (Devry Institute of Technology in Alpharetta Ga.).
Attended (University of Staten Island College).
References
First Name Adrew
Last Name
Horry
Employer
Banking
Title
Titles dept
Phone Number
Type Email Address
Personal
How long have you known this person?
35 years or more
Relationship
Friend
First Name
Max
Last Name
Dunlap
Employer
Morgan Stanley
Title
Supervisor Wealth
Phone Number
Type
Occupational
Email Address
*************@*************.***
How long have you known this person?
2-3 years
Relationship
Professional
First Name
Stacey
Last Name
Johnson
Employer
United Health Care
Title
Clinical RN
Phone Number
Type
Occupational
Email Address
********@***.***
How long have you known this person?
4-7 years
Relationship
Professional
First Name
Terrie
Last Name
Curbison
Employer
Title
Bristol & Meyers
Phone Number
Type
Personal
Email Address
******.********@***.***
How long have you known this person?
25 years or more
Relationship
Friend
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