Clinical Manager Resume Example

Versatile and accomplished Healthcare Finance Leader with 15+ years of senior-level experience leading finance operations in the Medical field. Proficient at working with insurance providers and hospital services to develop the best possible solutions for all parties. Strengths include: financial reconciliation, record keeping, team leadership and Healthcare Administration.

Department Leader /Medstar Health / Credit Balance Department / Baltimore, MD / 11/2016-07/2017

• Communicated with clients ensuring that medical information pertaining to HIPPA was maintained on a private status.
• Managed Insurance Overpayment Requests for Inpatient and Outpatient receivables for all hospital units.
• Prepared quarterly Medicare 838 reports and managed annual Medi-Cal Credit Balance audits following the weekly Insurance Liability Bulks.

Credit Reimbursement Specialist II / Medstar Health / Baltimore, MD / 04/2011-11/2014

Key functions:

• Determined credit balances were accurate by reviewing account transactions and the explanation of benefits, if applicable.
• Identified and prompted processing of eligible refunds for both patients and insurance companies.
• Received and processed payer correspondence and refund requested fax, and written correspondence and pricing agencies.

Insurance Specialist/ Medstar Health / Baltimore, MD / 08/2007-11/2014

• Identified and resolved accounts denied on payment remittance and/or electronic status reports.
• Managed escalated consumer complaints using response system and active customer service skills.
• Verified accounts were adjusted after original bill and referred accounts to appropriate personnel or re-bills with corrected amount.