Medical Billing and Collection Specialist

SUE PAYTON

OBJECTIVE

I am interested in securing a career-oriented position, which allows me to make vital contributions while gaining professional growth opportunities.

EXPERIENCE

****- ****ent Mental Health Provider Assistant

2001-2005 Colorado Springs Radiologist/ Penrad Colorado Springs, CO

Billing office Manager

Establish atmosphere of trust and support in the business office, encourage positive employee relations, provide leadership and support for staff and to continually find methods to build and promote teamwork.

Problem resolution, streamline work flows, implement changes and improvements, implementation of new procedures and the developing of cross training programs.

Interview and hire, annual review, Disciplinary/Hr issues.

Monitoring and maintaining department accuracy and turn around time,

Monitoring the AR to and find ways to reduce aging, managing of administrative cost, seek ways to improve quality and customer service.

Handling of customer complaints

Identify employee strengths and utilize them appropriately.

2000-2001 Pacific Health Dimensions Colorado Springs, CO

Provider Relations Coordinator

Office education for the Providers and their office staff, to provide them with the educational materials as needed.

Work with the contracted health plans, close association with the health plan provider, and assist contract manager with contractual issues.

Be available by phone to assist all Physicians and Providers.

Work with the health plans concerning HEDIS & NCQA

Meets with the offices concerning claims /or medical management issues.

1999-2000 CIGNA Healthcare Overland Park, KS

Provider Relations Representative

Education of the Providers and the office staff in the differences in the contracted products ( HMO, PPO, GPPO, POS)

Conducted site reviews to meet CIGNA and NCQA guidelines.

Provided general education sessions, prepared educational material for providers and staff.

1998-1999 FMH Benefits Services Overland Park, KS

Claims Dept Supervisor

Supervised a group of 20 individuals who processed claims for one of the groups largest TPA??s. Handled appeals, Performance reviews and any discrepancies that may arose with the insured or Providers.

Conducted the training of all the examiners in all aspects of claims adjudication.

Reviewed and recommended appropriate actions to resolve questionable issues on claims.

Identified and defined specific problems encountered and presented recommendations.

1994-1998 Centennial Ins CO Lenexa, KS

Claims Adjuster/ Customer Service

Travel on-site to investigate and evaluate all relevant facts to determine coverage, damages, and claim value on first party property claims.

Inspection of losses required including accurate scoping and damage estimating.

Provided excellent customer service to meet the needs of insureds, agents and all internal and external customers.

Strong investigative and negotiation skills. Independent worker, self starter.

2 years of auto claims experience. Good working knowledge of Property repair practices and the ability to write, read and adjust estimates. Get agreed repair and replacement prices with contractors, vendors, etc.

Processed claims for the insureds and the providers.

Assisted the agents / Providers on the claim discrepancies on a daily basis.

Corrected and adjusted the customers claim in a timely and efficient manner.

Dealt with the Providers on the telephone and through correspondence, conducted all the medical investigations, including the requesting of all records.

EDUCATION

Pikes Peak Community College Colorado Springs, CO

B.A., Business Administration.

Contact this candidate