Manager Medical

Sherie M. Gaisoa

**** ****** ***** ** #****

Arlington, TX 76006

480-***-**** cell

*******@*****.*** & *******@*****.***

Objective

To obtain a challenging position, with the opportunity for growth and advancement

Work History

Texas Health Resources (CBO) temp to hire 04/2008 perm-10/2008/-CURRENT

Hospital Lead Appeals -Pt Acct III Rep/Third Party – Aetna/Humana

Research all credit balance accounts to determine appropriate refund

Research denials & underpayments from payers (Aetna & Cigna), Appealed as needed

Calculate necessary adjustments, discounts, write-offs according to contract or department policy

Contacting physicians, patients, medical records department, and/or Utilization Management as needed.

Process appeals within appropriate timeframe to ensure maximum reimbursement

Maintain paper work flow and special project assignments

Meet and or exceeded the production standards set by THR

Schaller Anderson of Arizona 1/2005-2008 / AETNA – 3/2008

Sr. Billing Consultant /Research & Adjustment Analyst

Plans worked:

CHOC/UCMN 1/18/2005-6/2005 – Supervisor Regina Vazzeria

ALL COMMERCIAL 6/2005-4/2006- Supervisor- Kaye Buist

MHIP/CHW/SCRIPPS - 4/2007- 5/2007 Supervisor- Kaye Buist

Mercy Care (medical & dental) – Supervisor-Jeannette Eichenberger 2007/2008

• Adjudicated, Researched/ & resolved claim issues per policy set by Schaller Anderson/Aetna, Medicare & AHCCCS

• Met/exceeded claim production and quality standards

• Assisted call center with inbound calls for claims status and claims issues.

• Coordinated COB/ TPL- benefits for numerous plans.

• Assisted Supervisor on special projects & with MHIP, MPC, CHW, Scripps & Dental RAA workflow

• Identified configuration, processing and billing issues; facilitate resolution

• Assisted with Provider incoming call center

Health Choice of Arizona 2001-12/2004

Claims processor/Research & Adjustment Analyst

*Manager – Joan Toland (currently Manager @ Aetna & Jennifer Hayes (currently BAM Manager @ Aetna of Arizona)

• Adjudicated, Researched/ & resolved claim issues per policy set by Health Choice

• Met/exceeded claim production and quality standards

• Coordinated COB and TPL- coordinated benefits for numerous plans.

• Assisted Supervisor on special projects

Education

• NOVA INSTITUTE OF TECHNOLOGY California - 10/25/1999 – 09/29/2000

• Medical billing Specialist- Diploma*

• Medical Coding – certificate of course completion*

• ICD-9, CPT, Medical Terminology, human anatomy courses completed

• Cum GPA – 3.63 - 54 credits

• High School Diploma

Skills

• Strong front office and phone skills

• Knowledge of medical terminology

• Knowledge of CPT coding guidelines

• A positive team player

• Self-motivated

• Detail and goal oriented

• Dependable and able to multi-task

• Studious and eager to learn

• Strong customers service skills

• Communication, written and excellent interpersonal skills

Office equipment experience

• OAS Invision/Gold

• Navi Net

• Denial Papers data base

• Siemens Medical solutions

• Microsoft Office/Word

• Microsoft Outlook

• QNXT

• QMACS

• PC skills

• Additional office equipment

References

Howard Mc Beth

Dept. Manager

Texas Health Resources

Joan Toland

Manager

Schaller Anderson/Aetna of Arizona

Kay Buist

Supervisor

Schaller Anderson/Aetna of Arizona

Jennifer Hayes

BAM Manager @ Schaller Anderson/Aetna of Arizona (current)

Manager of Health Choice of Arizona (previous)

*Contact info available upon request

Darla Tovar

Spiritual Advisor

Personal reference

Cell 214-***-****

Contact this candidate