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Healthcare Insurance Claims/ reimbursement (A/R

United States
March 27, 2011

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OBJECTIVE To participate in a progressive forward thinking environment committed to excellence in Healthcare/Management/Administration which allows me to utilize my many years of leadership, training and office management skills.


• Office Management/Team Leader experience. Proven problem solving skills, and ability to make cost effective business decisions.

• Ability to manage multiple priorities effectively in a fast paced environment. Analytical, detail oriented, & flexible

• Success oriented with high energy and positive mental attitude.

• Team player with proven leadership qualities. Self-starter able to work with minimal supervision

• Excellent customer service, organizational, and negotiation skills.

• Outstanding verbal & written communication skills.

• Exceptional interpersonal skills with the ability to work effectively in diverse groups

Customer Service/Telephone Agent – (Volunteer) 2010 to present

John C. Lincoln Hospital/ Breast Health and Research Center, Phoenix , AZ

Work as a volunteer in the scheduling department answering inbound calls from patients wanting to schedule appointments.

Fax documents, mail-out result-letters to patients. Contact patients to pick-up educational packets.

Payment Specialist/Revenue Management Dept. 2005 to 2008

University Physicians, Inc. Aurora, CO

Responsible for auditing Department of Medicine Insurance claims to confirm that payment variances on monthly reports are reimbursed according to UPI Managed Care Insurance contract(s).

Appeal and resolve claims not paid per Managed Care Insurance contract(s). Work closely with provider relations representatives per specific managed care insurance contract(s). to facilitate and resolve outstanding issues assuring correct and proper reimbursement of claims in a timely manner.

Review, isolate and resolve repetitive problematic denial patterns of reimbursement of all claims.

Utilize all available resources (via insurance websites, code manager program, CPT reference materials and, Medicare fee schedules) to assure claims requirements follow conditions for correct reimbursement.

Insurance Claim Specialist 2003 - 2004

Pacific Medical Centers, Seattle, WA

Responsible for paper & electronic claims pre-audit and submission to insurance payers.

Daily audit of denied claims work file for immediate follow-up for increased reimbursement. Follow-up by contacting the carriers by phone, fax, e-mail to resolve denials. Contacting patients & providers for referral copies. Appeals for timely filing and denials in error. Working with provider relations reps to resolve provider group claims issues.

Daily ATB claims review of unpaid claims for all lines of business including Medicare, DSHS, Tricare, Managed care contracted & delegated health plans and commercial insurances. Responsible for reducing A/R accounts from 1600 to 393 in June04 with a 75% actual reimbursement rate. Reduced aging by ensuring that insurance contract conditions are met and that all requirements follow compliance regulations.

Patient Access Financial Counselor 2002-2003

Overlake Hospital Medical Center, Bellevue, WA

Responsible for insurance verification, referral management, authorization, and pre-certification on all Inpatient/Same Day Surgery hospital admissions.

Acted as primary liaison between OHMC scheduling departments, Care Management, Business Office, patients, physician’s offices and insurance carriers.

Provided exemplary customer service in managing all aspects of patient accounts. Collected appropriate monies, notified patients/physicians office staff of hospital billing policies and services.

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Patient Access Coordinator 2002-2003

Overlake Hospital Medical Center, Bellevue, WA

Represented Overlake Hospital as the welcoming official to all patients and visitors who contact or enter the facility.

Performed pre-registration for all scheduled patients which consisted of determining demographic, financial and clinical information to data enter into computer system.

Documented electronically and managed all patient self pay obligations either in writing or via telephone.

Scheduled patients for Inpatient/ Outpatient, Radiology and all other areas of the hospital.

Business Office Team Coordinator II 2001 - 2002

Pacific Medical Centers, Seattle, WA

Business Office Operations for Eye Care, ENT & OB/GYN Specialty clinics

Provide leadership and support of the daily operations of the Business Office functions for 20 practioners & 35 ancillary and support including scheduling & timekeeping. Hands-on leadership by providing information and assistance on process knowledge, operating policies, procedures, technical skills, and system basics

Liaison between the front office operations and providers for communication and problem resolution. Facilitated resolution of customer service problems. Recommended, implemented, and executed process improvement solutions for the Business Office. Develop departmental plans, set goals and deadlines

Trained ancillary staff for patient registration, appointment scheduling, basic telephone greetings, & triage for same urgent appointments. Personnel development for increased employee retention. Recruit for personnel positions and provide input for performance appraisals Monitored call volumes and staff coverage to ensure customer service level requirements are met.

Promoted to manage Eye Care & ENT clinics in addition to the OB/GYN Clinic

Business Office Team Coordinator I

Pacific Medical Centers, Seattle, WA 1999 – 2001

Maximized financial returns for clinic by implementing standardized processes.

Reduced re-work & enhanced collections with upfront collections of co-payments, cash collections; professional billing, and insurance registration at each appointment.

Provided routine and complex financial counseling for patients

Participated in the planning of on-going staff development programs.

Promoted to facilitate and support the daily operations of the Business Office functions and clinical operations of OB/GYN clinic.

Patient Service Representative / Business Office Team Lead 1997 - 1999

Pacific Medical Centers, Seattle, WA

Performed routine and complex form coding for ambulatory professional services.

Referral processing for all incoming & outgoing referrals. Provided customer service and facilitated daily clinic flow. Patient registration for updated demographics.

Liaison for clinic staff and providers with Corporate Business Services insuring all billing encounters were coded to for the highest level for optimal reimbursement within billing guidelines & industry standards.

Processed Patient Assistance applications for charity care & self pay discounts.

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Associate of Arts Degree, Los Angeles City College

Dental Assistant Certification, Los Angeles City College

Human Resource Management Certification, Seattle Central Community College,


IDX Software Program

Microsoft Office Programs

Insurance Contracts

Leadership Management Challenge

Leadership Management Conflict Resolution

Cultural Diversity Awareness Training

HIPPA Compliance Training

Coding Compliance

Safety/Disaster Training

CPT-4 Coding

ICD-9 Coding

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