Insurance Quality Assurance
Resume:
Lloyd Dale Brown II
Richardson, Texas 75080
Email: *********@*****.***
Objective: To obtain a career in the business management or insurance field that will use my abilities and strengths to continue to grow and make a contribution.
Education: B.B.A in Entrepreneurship and Strategic Management
University of North Texas 2003
Employment Experience
EMBCC Dallas, TX April 2010-Present
Quality Assurance Analyst II
• Publish and/or present audit findings and metrics to key figures throughout the company, including executive management and corporate head staff.
• Assist in development and implementation of new metrics and audits including Policy and Procedure documents.
• Conduct quality reviews of departmental policies, procedures and practices to assure compliance with established quality standards.
• Gather audit findings on standard posted transactions, verify figures, and review documents to ensure that they are correct.
• Verify the accuracy of information entered in Flowcast and complete special projects to ensure the correct documentation in Flowcast.
Worker’s Compensation Insurance Analyst
• Accurately and timely obtain resolution of patient accounts which includes insurance carrier denial reports, insurance carrier correspondence and insurance carrier no response reports.
• Prepare appeals relating to coding, provider enrollments, and payment processing issues.
• Responsible for reducing the accounts receivable to cash, identify, and resolving insurance claim denials, communicate reimbursement and billing system problems.
EmCare, Inc Dallas, TX June 2006-Feb. 2009
Insurance Specialist
• Processed certificates of insurance for physicians, credentialers, and hospitals to ensure and confirm malpractice coverage for EmCare practitioners as a Risk Insurance Specialist.
• Maintained Worker’s Compensation policies and procedures and also handled and reported Worker’s Compensation claims for all EmCare clinicians and non-clinicians to Worker’s Compensation carrier.
• Created spreadsheets for physician enrollments into various state funds for mandatory supplemental insurance coverage.
• Reviewed physician requests for additional coverage for non-contracted services.
• Performed claims histories and background checks for all physicians for the credentialing process.
• Maintained professional liability policies and policy administration.
• Conducted mail audit surveys for Worker’s Compensation and reported payroll information to various state Department of Labor Boards.
• Processed and sent letters of tail coverage to all physicians informing them of coverage after employment with EmCare.
AIG Claim Services Dallas, TX May 2004-June 2006
Medical Only Specialist
• Handled Worker’s Compensation claims in Texas and Oklahoma as a Medical
Only Specialist.
• Managed medical treatment of claimants and assigned nurse case managers to lost time files in order to coordinate return to work efforts.
• Issued payments of indemnity benefits to claimants in Texas and Oklahoma and maintained contact with claimants and clients.
• Approved claim payments for treatment of injured workers and contacted providers for medical reports.
• Reviewed medical reports and properly documented files with updated information with action plans included.
• Assigned reserve values to claims at the probable ultimate cost of the claim.
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