Amsa Float, Monday Friday 40 Wk resume example

● Single-handily works and maintains the company's Worker Compensation program while managing the OSHA Log for the Boston station resulting in meeting annual deadlines

● Works closely with the Safety & Quality Manager to ensure that the Claim Reduction Program and Standard Operating Procedures are being followed & contribute to procedural and operational audits

● Monitor days out of work log & follow up with what can be done to get the injured employees back to work as soon as possible

● Monitor claims cost & update spreadsheet with Reserve increase/decrease

● Participate in the Monthly Safety Committee Meeting and posted safety and near misses bulletins

● Work closely with company's Adjuster to put procedures in place to help cost control and refined turn around time on receiving all other related injury documentation resulting in effective communication

● Provided effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process

● The point of contact for 4 business lines for all documentation regarding incident, includes internal safety notify and investigation details, as well as any health information relevant to the claim

● Responsible for daily management of account receivable process and follow up in the billing system, including daily screening and correction of claims for accuracy for the surgical department
● Reviewed, corrected and completed edit queues weekly for the particular insurances assigned for the surgical department
● Follow-up on pending claims, includes following up with the insurance company, document the findings and gather/send the necessary documentation to process the claims
● Responsible for the appeals process, which included researching payer websites, pulling of documentation such as EOB's, requesting medical records, and reviewing registration, eligibility and benefits, as well as documenting all work performed on the patient invoice.
● Handled customer service calls and demonstrated excellent customer service skills, resulting in 95% patient understanding
● Handled confidential information with accordance with HIPAA standards
● Conducted research on forensic account balances that have been open for over a year or more by reviewing invoices history to determine payments/retractions and inform management of discoveries for swift resolution
● Provide Management with analytical data and trend analysis that occur within insurance carriers

● Processed medical referrals for 5 providers in a timely manner to include, but not limited to, completion of service request (direct and prior authorization referrals) forms manually and/or through EMR & request for medical documentation upon completion of the referral

● Faxed service requests to Utilization Management department for approvals

● Processed and send requests to the specialty offices for processing and scheduling of patient appointment

● Notified patients of scheduled appointments by phone, in person with appointment information or by mail and documented in the patients chart

● Obtained insurance information from patients, which included collecting co-payments and self-paid balances

● Processed consult reports that were received, completed and closed referrals in the patient's charts

● Reported referral problems to providers, supervisor and administrator

● Reviewed referral log daily and provided weekly progress reports to supervisor and administrator

● Worked closely with outside vendors such as Utilization Management, Provider Services and Contracting Department to establish and build effective working relations

● Single-handily managed, worked, maintained, and closed a backlog of two years of clinic referrals, denials and authorizations within the first year of employment