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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Professional Summary
Auditor with management experience and exceptional people skills. Versed in Medical Claims and Medical Coding. I am looking to join a growing entrepreneurial organization as part of the Executive team.  Experienced manager with excellent client and project management skills. Action-oriented with strong ability to communicate effectively with technology, executive, and business audiences.
Licenses
  • Certified Coding Specialist American Academy of Professional Coders License
Skill Highlights
  • Knowledge of HMOs, personal and professional integrity
  • Financial aptitude Sound decision making Research Abilities
  • Claims analysis and review specialist Staff training and development In-depth claims knowledge
Results-oriented
Quick learner
Computer proficient
Training and development
  • Medical Manager Software
  • Managed care contract knowledge
  • Electronic Medical Record (EMR) software
  • Neurology billing expertise
  • CPT and HCPCS coding
  • Internal medicine billing
  • HIPAA compliance
  • Strong planning skills
  • Strong work ethic
  • Team player with positive attitude
Professional Experience
Coder/Collector, 02/2013 to Current
Dlt Solutions, Inc.Edison, NJ,
  • Planned and executed Inmate Claim Procedures. Calculated figures such as discounts, percentage allocations and credits. Suggested process improvements to secure prompt and regular receipts for the organization.
  • Researched and resolved billing and invoice problems. Thoroughly investigated past due invoices and minimized number of unpaid accounts.
  • Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
  • Resolved and clarified issues with patient accounts and collaborated with local clinics.
  • Applied payments, adjustments and denials into medical manager system.
  • Posted charges, payments and adjustments.
  • Carefully prepared, reviewed and submitted patient statements.
  • Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.
  • Consistently informed patients of their financial responsibilities prior to services being rendered.
  • Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
  • Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
A/R Specialist, 04/2012 to 2013
HealthpartnersEden Prairie, MN,
Corresponded with operations staff to ensure key client deliverables and revenue goals were met.
  • Front Desk & Check In/Out Took copays & past due balances at check in counter.
  • Scheduled and Pre-cert MRI's, and made follow up appointments at check out.
  • I made daily reminder calls to the patients of their appointments & balance due.
  • Billed and collected on aging & current accounts.
  • Worked with a collection company to get paid due accounts off the books.
  • Answered phones and routed calls to Nurse's line.
Medicare Coordinator, 06/2011 to 05/2012
Cognizant Technology SolutionsVirginia Beach, VA,
  • Worked Special Projects as directed by my Supervisor.
  • Corrected claims in IVANS daily in order for the claims to pay in sequence for 13 Skilled Nursing Facilities.
  • Followed up and collected on past due claims.
  • Contact person for all Medicare claim issues for the Nursing Facilities 502-345-9474lelehna1@aol.com.
Central Billing Coordinator, 05/2010 to 05/2011
Unity Health InsuranceMadison, WI,
  • Corporate office of 19 Skilled Nursing Facilities and 43 Assisted Living Facilities Maintain AR accurate and prompt billing.
  • Post all cash receipts, file all adjustments, File all NO Pay bills to Medicare.
  • Process all refunds; File the Medicare Credit balance Report.
  • Send out Patient Statements; make sure all Administrators are following our collections and Bad Debt policies.
  • Analyze outstanding accounts Receivable and process old outstanding claims.
Technical Support, 05/2009 to 05/2010
Metroplus Health PlanArmonk, NY,
  • Cross-trained and provided back-up for other customer service representatives when needed.
  • Extensive knowledge with the ZirMed system/ALL functions.
  • Answer incoming calls from customers, vendors, Intermediaries and payers, Assist customers with overall website inquires/Support Emails, communicate effectively with internal & external departments.
  • Handle escalate calls and issues for full resolution.
  • Participate in internal and external conference calls as well as face to face internal and customer meetings.
  • Investigate complex EDI issues and determine resolution.
Provider Claim Rep, 06/2008 to 05/2009
Passport HealthcareCity, STATE,
  • Answer incoming calls from providers regarding managed care issues.
  • Review claims for reconsideration Supported providers in order to get their problems/issues.
  • Work appeals and correspondence review for reprocessing per the Medicaid/Medicare rules.
Claims Examiner, 03/2006 to 06/2008
MedplansCity, STATE,
  • Paid claims daily that didn't make first pass.
  • Reviewed & Reworked claims that were paid incorrectly.
  • Priced claims per their individual contracts and per coding before paying.
  • Pay per performance.
Claims Auditor, 04/2000 to 02/2006
The Rawlings GroupCity, STATE,
  • Obtained relevant evidence and information regarding suspicious claims.
  • Identified and collected evidence and determined its value to a specific claim.
  • Reviewed clients systems to determine if claims were paid per coordination of benefits.
  • Revamped accounting quality system to prepare for important audits.
  • I communicated with Medicare, Patients, and Employers.
  • Was a Mentor for new employees.
  • Constructed training manuals and implementations of new clients.
  • Trained new employees.
Education and Training
Bachelor of Science: Business Management, Expected in
Sullivan University - Louisville, KY
GPA:
Business Management
Skills
Accounting, accounts Receivable,  AR, balance, benefits, billing, com, contracts, Credit, clients, decision making, documentation, EDI, Financial, insurance, medical manager, meetings, Mentor, office, Nursing, policies, problem-solving, coding, quality, receiving, Research, Sound, Staff training, Supervisor, phones, training manuals, website

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Resume Strength

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Resume Overview

School Attended
  • Sullivan University
Job Titles Held:
  • Coder/Collector
  • A/R Specialist
  • Medicare Coordinator
  • Central Billing Coordinator
  • Technical Support
  • Provider Claim Rep
  • Claims Examiner
  • Claims Auditor
Degrees
  • Bachelor of Science

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