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CLAIMS MANAGER Resume Example

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CLAIMS MANAGER
Professional Summary

Driven and compassionate healthcare professional with 14 years hands-on experience in fast-paced environments. Accountable and responsible with a strong focus on customer service.

Education and Training
B.A : Social Sciences Personnel Psychology/Human Resources Business Administration, May 2015Washington State University - Vancouver, WAGPA: GPA: 3.83Social Sciences Personnel Psychology/Human Resources Business Administration GPA: 3.83
Associates : Arts, 2013Clark College - Vancouver, WAGPA: GPA: 3.68Arts GPA: 3.68
Skill Highlights
  • Staffing management ability
  • Proven patience and self-discipline
  • Motivation techniques specialist
  • Personal and professional integrity
  • Relationship and team building
  • Staff training and development
  • Claims analysis and review specialist
  • Critical thinking proficiency
Professional Experience
CLAIMS MANAGER
March 2015 to March 2016BeneSys, formally A&I Benefit Plan Administrators, Inc. - Portland, OR
  • Created annual goals, objectives and budget and made recommendations to reduce costs.
  • Carefully selected, developed and retained qualified staff, as well as trained new staff annually.
  • Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.
  • Minimized staff turnover through appropriate selection, orientation, training, staff education and development.
  • Conducted or approved the performance evaluations for all department employees.
PAYOR CONTRACTING AND ACCREDITATION MANAGER/PAYOR RESEARCH MANAGER
October 2001 to October 2014RS Medical - Vancouver, WA
  • Completed credentialing packets, requests for credentialing information, and Medicaid re-validations.
  • Assessed, analyzed and negotiated pricing, contract terms and conditions.
  • Maintained contracting data and pricing in the payor database.
  • Prioritized and managed contracts for Commercial plans, including all lines of business, affiliated providers, Workers Compensation Carriers, PIP insurance companies, Medicaid, Medicare and Veterans Administration.
  • Managed VA Award by completing and submitting Federal Supply Schedule Modifications, Administrative Changes and Subcontracting reports.
  • Improved contractual relationships through development and implementation of strategies to streamline processes with internal departments.
  • Monitored accreditation standards, conducting gap analysis, and developing action plans to address identified deficiencies.
  • Created and managed multiple accreditation project plans with task coordination across department at all levels of the organization, and remotely with out of state locations.
  • Queried, developed and analyzed ad hoc reporting to measure reimbursement trends and make recommendations for improvement.
  • Established and maintained effective internal and external working relationships while serving as the contacting and credentialing point of contact.
  • Served as project manager for high profile initiatives.
  • Developed meeting agendas, managed timelines, delegated tasks, reported progress and worked cross-functionally to develop procedures to support initiatives.
REGIONAL OPERATIONS MANAGER/FUNCTIONAL MANAGER
BENEFIT VERIFICATION/ACCOUNTS RECEIVABLE LEAD
  • Provided leadership to a team of 50 employees.
  • Responsible to manage daily operations, develop, implement regional organization strategies, and allocate resources within the department.
  • Successfully reduced billing back-log by 14 days and employee turnover by 18%.
  • Achieved and maintained a claim to conversion rate of over 80%, electronic billing error rate of less than 2% and a billing audit error rate of less than 10%.
  • Established and implemented goals, objectives, policies and procedures related to billing operations.
  • Monitored, evaluated effectiveness and progress of objectives using designated benchmarks.
  • Recruited employees, trained, supervised and evaluated staff based on needs to support set objectives.
  • Coordinated the redesign of billing training binder, coached and audited new hires.
  • Provided expertise in the area of insurance billing, reimbursement and collections.
  • Oversaw the supervision of personnel, including implementing personnel actions and motivating employees to achieve peak productivity and performance.
  • Resolved staff grievances and carried out disciplinary actions.
  • Coordinated and prepared periodic reports to include productivity, quality of performance and status of achieving business objectives.
  • Provided budgetary information to director and assisted in expense management.
  • Participated and served in multiple committees, pilot programs and cross-functional teams, including working with multiple consultants and contractors.
  • Examined, re-engineered operations and procedures, formulated policy, developed and implemented new strategies, procedures and training to support new lines of business, product roll-outs and effective billing processes.
  • Supervised a team of 16 Benefit Verification and Accounts Receivable professionals including managing schedules.
  • Prioritized and delegated work flow to achieve departmental goals, successfully reducing back- log by 11 days and improving audit scores by 10%.
  • Worked with team to identify payer issues and develop efficient processes.
  • Expert knowledge of DME2 software and order processing to include benefit verification, pre-authorization, billing and collections for all commercial lines of business, as well as State Medicaid.
  • Resolved escalated patient issues and documented in complaint system.
  • Participated in cross-functional teams to develop software enhancements and organizational procedures.
  • Managed and coordinated department recruiting and selection with Human Resources.
  • Participated in onboarding to include training, coaching, and 90 day reviews.
  • Prepared and presented performance reviews and individual development plans.
Skills

Accounts Receivable, Administrative, streamline, ad, billing, binder, coaching, contracts, conversion, database, functional, Human Resources, insurance, leadership, director, managing, organizational, peak, performance reviews, personnel, policies, pricing, processes, progress, project plans, quality, recruiting, reporting, develop software, supervision

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Resume Overview

Companies Worked For:

  • BeneSys, formally A&I Benefit Plan Administrators, Inc.
  • RS Medical
  • BENEFIT VERIFICATION/ACCOUNTS RECEIVABLE LEAD

School Attended

  • Washington State University
  • Clark College

Job Titles Held:

  • CLAIMS MANAGER
  • PAYOR CONTRACTING AND ACCREDITATION MANAGER/PAYOR RESEARCH MANAGER
  • REGIONAL OPERATIONS MANAGER/FUNCTIONAL MANAGER

Degrees

  • B.A : Social Sciences Personnel Psychology/Human Resources Business Administration , May 2015
    Associates : Arts , 2013

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