Customer Service Medical Billing

CHERYL R.HOPSON, BA

** ********** ****** ******* ** 07753 732-***-**** *************@*****.***

Innovative, ambitious, and results-driven with 5 plus years in Hospital/physician billing and 10 years in

Credentialing also acted as a liaison to oversee complex, high-profile projects which require coordination of

multiple resources while maintaining the ability to determine a better business relationship with in network providers

by satisfying their needs. Excellent motivator and team player with the attitude for assessing corporate needs and

delivering programs that meet goals while remaining within budgetary guidelines. Understands the need to get the

job done. Accurate, detail oriented with extensive experience in the insurance and healthcare field. Able to meet

deadlines, ability to research weekly a/r report to insure accurate payments to providers. .Strong organizational skills

and work independently or along with team; proficient in Microsoft Office Applications, Rumba systems, Maccess,

and strong customer service and analytical skills. Skill set in Auditing Insurance claims and in billing and coding.

Areas of Expertise

Office Management

Provider retention vs. termination

Internal Auditing

Physician Relations

Evaluate and Interpret Provider Contracts

Report & Document Preparation

Spreadsheet & Database Creation

Accounts Payable/Receivable

Joint Commission Regulations from the Insurance end

Provide highest level of customer service Records Management

Meeting & Event Planning

Physician Office reconciling of accounts receivables

Medview

Experience

Healthnet Inc

150 E 42nd Street

New York, NY 2008 to 2011

Provider Relations Representative

Liaison between Healthnet and the participating providers of Nassau, Lower Manhattan, Westchester, Orange and Rockland counties. Performed periodic site visits performed upon provider request or a participating of one of Healthnet’s policyholders. Ensured the company that providers remained in compliance with their contract as well as the Department of Insurance for the city of New York. Maintained Physician database. Facilitate and supported the credentialing process. Completed provider request accurately and in a timely manner.

• Recruit potential providers from Sales and Marketing disruption reports, Provider nominations and/or OON reports.

• Facilitate and support the Credentialing process.

• Conduct site visits for Primary Care Providers and OB providers per credentialing guidelines.

• Conduct annual IPA/PHO and/or large group orientations.

• Orient contracted providers to Health Net programs and company events.

• Conduct regularly scheduled visits to provider site and respond to Network issues.

• Complete provider visit summary.

• Ensure that providers are adequately supplied with the provider manual and quick reference guide.

• Identify opportunities for maintaining a high level of service.

• Maintain ISF/CSFs less than thirty (30) days.

• Perform other work related duties as assigned.

• Maintain provider database.

• Organize claim projects to be completed within requested timelines

Healthnet Inc

90 Matawan Rd

Matawan, NJ

2006 to 2008

Audit Analyst

In the position as an Audit Analyst, it is a requirement to maintain a comprehensive working knowledge of Health Net Policies in support of Health Plan Operations. Part of what’s required is to complete audits on new hires to ensure timely feedback to the training team. Proactively identify and report adverse trends and patterns provide recommendations for quality improvement. The ability to conduct an audit within the company while insuring compliance is followed per state regulations and company guidelines.

Healthnet Inc

90 Matawan Rd

Matawan, NJ

2002 to 2006

Resolution Specialist

Research and interpret negative remits according to the established policies and procedure. Interpret the Health Net remittance advice and communications to providers and/or their office staff as needed. Answer inquiries from members, providers, employers and all other Health Net customers.

Research negative balances on remittance advices and make necessary arrangements to correct any discrepancies.

Release medical claims for adjudication.

Education

Hightech Institute Phoenix, AZ

B.S /Health Management

Hightech Institute

Associates Degree/Medical Billing and Coding

2006-2008

2001-2005

REFERENCES AVAILABLE UPON REQUES

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