To obtain a position in which I can utilize both my education and the skills and knowledge I have acquired in the health care environment from a reimbursement standpoint.
Education and Training
Duquesne UniversityMay 2000Bachelor of Science: Perfusion TechnologyPittsburgh, PAPerfusion Technology
Duquesne UniversityDecember 2002Masters of Health Management SystemsPittsburgh, PA
Confirm shipment of each order in the MSC system based by completion of a detailed Quality Assurance check of each order shipped to ensure that all Insurance and Accreditation guidelines have been followed.
Evaluate the medical documentation on file for each order and confirm that this documentation satisfies the Insurance requirements.
Adding Additional Information into MCS system to assure accurate claims processing such as wound detail, modifiers, and diagnosis pointers.
Communicate any errors found during the confirmation process to appropriate managers.
Process product returns in the MCS system - updating the Billing and Patient files to reflect returned product.
Monitor the Open Order Report to ensure that all shipped orders have been appropriately confirmed in the MCS system.
Customer Service Representative
Main Objectives: Receive orders by phone or fax and obtaining all information necessary to process the order.
Contact each new customer to inform them of the order and make them aware of any issues or delays.
Follow Insurance guidelines when preparing the order to be processed.
Utilize Insurance fee schedules to offer companion or alternate products when Insurance coverage limitations exist.
Contact Healthcare Providers to obtain any additional and/or supporting documentation to complete orders or notify of any delays.
Note any significant correspondence with the patient or referral source accurately in MCS files.
Complete an evaluation of the patient condition with every order and document this information in MCS files.
Insurance Verification and Authorization Representative Main Objectives: Enter customer demographics and orders into the MCS billing system including all information necessary for billing.
Verification of Insurance benefit information for patient's Primary and Secondary Insurance payors via contact with an Insurance representative or web portal.
Use this information to make a determination of a patient's insurance coverage for NR services.
Validate codes and fees to assure there is coverage under the patients policy.
Obtain Insurance authorizations when required by the Insurance.
Contact patients to explain benefits and financial responsibility for NR services and assist them with questions regarding their insurance coverage.
Obtain medical documentation from physician's offices or other healthcare professionals to support the necessity for supplies.
Contact referral sources and patients to discuss any problems or delays encountered during insurance verification.
Follow all HIPAA, Accreditation and Insurance guidelines during order processing.
McKesson Patient Care SolutionsDecember 2004 to CurrentSenior Manager Moon, Pa
Manage the daily operations of the Verifications, Documentation, and Confirmation teams.
Ensure orders are verified and authorized; documentation for billing is received, logged and filed; and orders are validated and confirmed.
Ensure all functions are performed efficiently, timely and accurately in order to achieve maximum reimbursement on revenue while maintaining regulatory, legal, contractual and company compliance.
Apply best practices, excellent customer service, and a positive and motivated work environment.
Establish departmental goals to align with company initiatives, and plan detailed strategy to achieve goals within a set timeline.
Assist Team Leaders in establishing team goals and review methods established by Team Leaders.
Ensure Team Leaders are achieving goals within set timelines.
Team Leader- Customer Service, Confirmation and Supplies Admin Teams Main Objectives Address daily questions/problems of team members and assist staff in bringing them to resolution.
Ensure that all action plans defining daily processes are implemented and consistently followed by all team members' .Address customer complaints at the supervisory level and bring them to resolution.
Assist Sales Representatives and other NR Managers with order processing issues, questions, and customer complaints.
Compile productivity reports monthly and conduct Productivity review meetings with each team member addressing any productivity numbers that are below the team standard.
Monitor the MCS Master Files - Ensure that accreditation and insurance requirements are being met.
Assist the Division Leader in creating bonus programs that are tailored to the team's daily order processing goals.
Monitor the order volume throughout the day and work with Team Leaders and Coordinators to ensure that the daily service level is achieved.
Run daily reports to monitor team productivity and efficiency.
Leader- Documentation Team Main Objectives: Responsible for creation and dissemination of all reports to the team for outstanding orders awaiting proper documentation to bill the respective payors.
Address any issues and concerns of the team and bring them to resolution.
Monitor productivity of all staff members.
Attend meetings and trainings to keep current on all compliance and insurance contract regulations and requirements and adapting any processes to comply with the policy.
Training of team members on all proper policies, procedures and valdidity of documentation requirements.
Monitoring revenue reports and reporting information to highermanagement and president during monthly meetings.
Maintenance and creation of reference tools through communication with contract team as well as AR and Billing departments.
Confirmation Team Leader Main Objectives: Managing team of Confirmation Specialists to ensure daily work responsibilities are completed and accurate.
Division and coordination of daily orders to team members.
Training of all team members.
Evaluation of needs of the team and made appropriate process changes.
Liaison between AR and Billing departments and the front end order processing teams.
Administrative duties such as payroll responsibilities and report creation and generation.
Internal Medicine AssociatesJanuary 2000 to January 2004Office Support Staff Ambridge, PA
Obtained all dictation for all patient interactions visit, phone call, etc., from all physicians in practice.
Attached dictation to proper patient chart and distributed to physicians for approval and validation.
Correction of any areas physician deemed inaccurate.
Receipt of medical information for patients, attached to patient files and distributed to physicians for signature.
Followed physician directives on any additional steps required with the information.
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Companies Worked For:
McKesson Patient Care Solutions
Internal Medicine Associates
Job Titles Held:
Customer Service Representative
Office Support Staff
Bachelor of Science : Perfusion Technology Masters of Health Management Systems
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