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
