Coordination Of Benefits (COB) Resolution And Recovery Coordinator Resume Example HAP/Health Plus Of Michigan

COORDINATION OF BENEFITS (COB) RESOLUTION AND RECOVERY COORDINATOR

Professional Profile

Business professional with twenty-five years experience seeking an opportunity to showcase skills. Core competencies include exceptional organization and efficiency, the ability to facilitate multiple projects simultaneously with excellent problem solving skills as well as excellent communication and time management skills. Handles tasks with accuracy and efficiency.

Experience

Coordination of Benefits (COB) Resolution and Recovery Coordinator
August 2013 to CurrentHAP/Health Plus of Michigan － Flint, MI

Developed and implemented a new automated process to streamline recoveries
Investigate and uncovered a software error that was creating lost revenue

Communicate with members and providers to resolve COB issues for facility, medical and pharmacy claims

Prepare, process and reconcile documentation and reports from various internal departments in order to ensure accurate and timely payment of claims

Investigate workers' compensation, automobile and accident claims

Maintain multiple spreadsheets and update information on all company software programs

Identify and recovering claims paid in error which provides an integral role in the revenue stream
Analize and interpret daily reports to maintain integrity of the software system
Continual review of Public Act 64, NAIC guidelines and other COB rule governing agencies in order to accurately determine primacy
Member of the HAP WEIC (Wellness and Employee Involvement Committee)

Claims Specialist
July 2007 to August 2013Health Plus of Michigan － Flint, MI

Led monthly process improvement meetings
Scanned incoming paper claims and maintain logs
Reviewed and process primary and secondary claims for payment

Routed claims to proper departments for resolution
Member of the Employee Involvement Committee

Medial Office Manager
March 1994 to February 2007Retina Vitreous Center － Grand Blanc, MI

Planned, coordinated and controlled daily operations of the organization.
Human resources: front office staff training, supervising front office, employee evaluations, employee interviews, hiring and discharges, conducting front office meetings, front office scheduling
Physician scheduling: coordinating physician meetings, vacations and travel, continuous creation and monitoring of schedules
Trained and supported users during new system implementations and upgrades.
Computer maintenance: create custom reports, maintaining physician and insurance company files, software updates, fee schedule updates
Physician credentialing: Ensuring physicians maintain staff privileges by keeping all paperwork current, verifying physicians maintain participation with numerous insurance companies, safeguarding confidential documents, maintaining online CAQH file
Low vision: oversight of Low Vision program, maintaining log of all services performed, review all charges, calculate fee splits between physicians
General business: create new business forms as needed,review daily edit report for discrepancies, review delinquent patient accounts, procuring of all office supplies, ensuring all medial equipment was properly maintained

Accounting Supervisor
July 1991 to March 1994Retina Vitreous Center － Grand Blanc, MI

Insurance billing: submitting claims, posting insurance payments, investigating insurance claim disputes
Payroll: Calculating employee weekly hours, updating and maintaining payroll deductions, tracking employee PTO hours
General business: Accounts payable/receivable, monthly reconciling of multiple bank accounts, preparing financial reports, accountant liaison, maintaining personnel files, resolving computer software problems, HIPAA compliance officer

Education

Bachelor of Arts : BusinessMichigan State University － East Lansing, MIEmphasis in Materials Management: Purchasing and Transportation

Skills and Affiliations

Proficient in Word, Excel, Outlook, AMISYS, ECRS, CMS and Reveal Software

Proficient in ICD 10, CPT and medical terminology

Resume Overview

Companies Worked For:

HAP/Health Plus of Michigan
Health Plus of Michigan
Retina Vitreous Center

School Attended

Michigan State University

Job Titles Held:

Coordination of Benefits (COB) Resolution and Recovery Coordinator
Claims Specialist
Medial Office Manager
Accounting Supervisor

Degrees

Bachelor of Arts : Business

Coordination of Benefits (COB) Resolution and Recovery Coordinator Resume Example

Resume Score: 100%

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