Workers' Comp Lien & Bill Review Specialist
Resume:
Michael Davis
Summary
●** years of hands on experience in financial analysis, billing, collections with proficiency in reporting, forecasting and accounts receivable.
●10+ years of hands-on experience managing collection, billing and financial for healthcare and medical clients.
●Expertise in collection procedures, collections, dialer, skip tracing, research, audits, A/R practices, and payment processing.
●Knowledge of codes including Labor, ICD 10, diagnostic, procedures as well as medical fee schedules and compensation data.
●Highly skilled contract negotiator for settlement of claims and providing resolution of legal issues before the WCAB with opposing counsel, pro per claimants and co-defendants
●Strong experience in conducting quantitative and qualitative analysis of data into meaningful insights on MS Excel for client comprehension.
●Proficient experience working on MS Office applications – MS Excel, MS PowerPoint.
●Strong communication skills with excellent analytical skills and strong ability to work in a high-pressured, metric and goal-centered work environment.
●Languages: Bilingual - Proficient in French and English
Sedgwick Claims Management Services Inc. Temp from 01/01/22-08/06/2022, then permanent
from 08/06/2022 to present
8125 Sedgwick Way
Memphis, TN 38125-1128
Title: Lien Representative - Bill Reviewer Department Lien Unit
Duties:
facilitate Lien negotiation with Work Compensation Medical Providers, and their representatives for the
Lien Unit.
Preformed Workers Compensation analysis for claims processing.
Initiate analysis on Dispute bills, Liens, invoices and contracts, EOB’s EOR’s
Determination of the statuses of Liens and disputed bills in regarding to EAMS search.
Maintain court calendar for Workers Compensation Appeals Board Lien appearance
Initiate request for court filings, I.e. Petition, Brief’s, filings, Points, and authority
Initiate request for OTOC’s, Lien conference, Lien Trials, Continuances etc.
Responsible for negotiation at the Workers Compensation Appeals board
Collaborated with Sedgwick Hearing Rep’s to strategize for Court appearance.
initiated Hearing Reports, Summary, Incidents reports
Maintained departmental Revenue Limits
Professional Experience
Cornerstone Medical Group, San Bernardino, Ca. June 2017 - Present
Senior Lien Representative
●Maintained millions in accounts receivable and initiated collection procedures on Workers Compensation med-legal accounts.
●Analyze Billings, Invoices, Contracts, Ageing reports to ensure due delinquency and compliances.
●Communicating with management on a weekly basis in regards to Declarations of Readiness and petitions
●Responsible for database updates
●Performed Worker’s Comp analysis and claims processing
●Performing collection functions and billing responsibilities.
●Negotiates commercial claims.
●Responsible for the Hearing Representative’s negotiations at the Workers Compensation Appeals Board
●Implemented of commercial Liens, for court filing
Rehab Solutions May 2015 - April 2017
Biller/Collector
●Communicating with management on a weekly basis in regards to Declarations of Realness and petition for medical records
●Responsible for database updates
●Performed Worker’s Comp analysis and claims processing
●Responsible for the hearing representatives at the Workers Compensation Appeals Board as well as collections, billing, and claims reconciliation as needed
Amerit-Consulting, Inc. Professional Service Oct 2014 - Mar 2015
Assignment: CareFusion, San Diego, CA
Portfolio Specialist/Analyst
●Analyze millions in accounts receivable and initiated collection procedures on outstanding Portfolio.
●Analyze Billings, Invoices, Contracts, Ageing reports to ensure due delinquency and compliances.
●Determined credit worthiness of customer to extend terms for purchase.
●Perform any database changes as needed in SharePoint
●Correct invoices as needed in SharePoint.
●Served as the Credit Liaison to the sales department
Superior Med Surgical, Rancho Cucamonga, CA June 2013 - Sep 2014
Collections/Billing Analyst
●Performing collection functions and billing responsibilities.
●Negotiates commercial claims.
●Implement due diligence procedures on HMLs and PPO contracts.
●Analyze accounts receivable
●Implemented commercial Leans for court filing.
Medi-Tech Specialty Services, Costa Mesa, CA July 2012 - June 2013
Collection/Billing/Lien Representative
●Performed collections, billings and court appearances for medical claims.
●Utilized knowledge of compensation data and Labor, ICD9, Diagnostic, and Procedures codes to analyze accounts and communicate information at Workers Compensation Board appearances.
VQ OrthoCare, Irvine, CA Aug 2011 - Jul 2012
Account Manager II
●Maintained millions in accounts receivable and initiated collection procedures on Workers Compensation med-legal accounts.
●Facilitated the analysis and collection of accounts receivable for billings on insurance claims. Applied payments to customer's accounts, negotiated settlements, and maintained A/R records.
●Settled liens on commercial claims.
●Assisted in the maintenance of the court calendar.
●Served as a resource to local branches for maintaining accounts receivables.
Michael Davis Independent Contractor, Temecula, CA Nov 2008 - Aug 2011
Independent Contractor - Legal Hearing Representative
●Initiated collection procedures on Worker Compensation Med-Legal accounts managing multi-millions in accounts receivable.
●Analyzed and reconciled billing on insurance claims; settled liens on commercial claims; analyzed accounts receivable and maintained court calendar.
●Negotiated and resolved lien matters as well as attended Lien Hearings at the Workers’ Compensation Appeals Board (WCAB). Reviewed, adjusted, and negotiated liens to prepare for and attend WCAB hearings from status conferences on the case-in-chief to lien trials.
●Utilized attention to detail, ability to prioritize, and excellent communication skills to provide timely responses to third-party administrators, insurance companies and self-insured entities to ensure prompt and reasonable disposition of liens, either by settlement or adjudication.
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