customer service and insurance operations manager resume example with 20+ years of experience

(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
Professional Summary
As an experienced billing manager for a medical laboratory I would like to utilize my previous experience to lead a team and display my leadership qualities.
Skill Highlights
Microsoft: Office: Access, Excel, and Word
Professional Experience
John Deere - Customer Service and Insurance Operations Manager
Dubuque, IA, 06/XXX7 - Current
  • Manage six exempt employees.
  • Responsible for Insurance Operations and Eastern Region Billing call center.
  • Answer 45,000 calls per month.
  • Maintain 86% first time call resolution measure.
  • Collect 3.6m dollars in cash annually.
- Insurance Operations Manager Insurance Operations
, , 05/XXX7 - 06/XXX7
  • Manage multiple functions within two Quest Diagnostics business units (Teterboro and Syosset).
  • Areas include reconciliation of Cash Receipts, Electronic Cash submission and remit, Denials processing, Research Denials, and Master file definition for the billing system.
  • Responsible to accurately track and post 50 million dollars in cash receipts per month.
  • Accomplishments reduced cost by 10% annually.
  • Reduced cost through automation.
  • Reduced 108 full time employees to 55 employees over 5 years.
  • Implemented automation in key areas.
  • Maintained a 90% employee satisfaction rating.
  • Increase cash receipts for changes in submissions and new software to improve the Research appeals resulting in and additional 360k annually.
  • Six Sigma greenbelt certification received in October 2006.
  • Responsible for , Quality Assurance, audits, system testing for new functionality\process improvements, and project management, including new billing best practices, lab initiatives, client interfaces.
- Quality Control \ Project Manager
, , 01/1 - 08/XXX7
  • Project leader for Quest Diagnostics Teterboro Business Unit for the testing and implementation of Hipaa Transactions standards.
  • Responsible to implement 17 Third Party Payer conversions.
  • Lead team through testing to implementation for 837 submissions and 835 remit.
  • Liaison between internal Information Technology teams and external Third Party payers.
  • Train Operations and turn over to production.
  • Maintain specifications by payer.
  • Define master file changes and implement.
  • This included mapping payer specific denial codes to standard ANSI codes defined in the Washington Published Standard transaction guides.
  • Reduce cost $200,00.00 by implementing automated denials, which resulted in six staff reduction.
  • Improve overall quality and productivity in the department resulting in the elimination of four positions.
  • In 2004 reduced staff to seven full time employees.
  • Responsible for QA audits, system testing, and project management, including upgrades to the billing system, site changes, lab conversions, special projects.
  • Review documentation; create test cases, data, and scenarios required for User testing.
  • Document and track issues for our internal Information Technology team.
  • Manage staff of eleven from 4-1999 to 4-2002.
  • Responsible for quality control and Training for Billing Functions.
  • Successfully reduced the error rate by 40% for several key areas.
  • Developed business rules.
  • Implemented a quality control review process that improved the effectiveness and accuracy of feedback.
  • Assisted in developing a company- wide standardization process for Quality Control.
  • Developed documentation, determined Business rules, trained staff and implemented quality review.
  • Ensured cross functions were not negatively impacted by changes to process.
  • Document processes.
- Billing Data Entry Manager
, , 01/1 - 01/1
  • Managed staff of forty-seven Billing Data Entry Representatives.
  • Responsible for front-end process.
  • Reduced backlog from 45,000 to 15,000 requisitions.
  • Identified billing issues attributed to this backlog.
  • Developed process to correct issues with account set -up.
  • Assisted with the reduction of missing information claims.
  • Managed workflow, ensured compliance, problem analysis, worked with internal departments and technical support to address billing issues to support Billing.
- Missing Information Section Manager
, , 01/1 - 01/1
  • Managed staff of thirty Customer Service Representatives.
  • Responsible for Missing Information collection.
  • Assisted in the implementation of productivity standards and monitored progress.
  • Managed workflow, ensured compliance, worked with system team for the implementation of a new billing system.
- Missing Information Section Manager
, , 01/1 - 01/1
  • Managed staff of fifty-two employees.
  • Responsible for client training and collection of additional diagnostic information needed for a new Medicare regulation.
  • This was a new team developed to handle medical necessity claims for Medicare.
  • Administrative support for two teams: customer service and data- entry team.
  • Managed workflow for the department, ensured compliance, and worked with system support teams to streamline the process.
- Billing System User Specialist
, , 03/1993 - 05/1996
  • Development of New Billing System Responsible for requirements gathering for a front-end billing system.
  • Re-engineered existing processes to identify areas of labor reduction and increased efficiency.
  • Ensured requirements were in compliance with all company guidelines and federal regulations.
  • Coordinated efforts with legal and management.
  • Served as liaison between software developers and end users to document existing processes, and selected best options for new applications.
  • Responsible for developing an access database of all company billing reports.
  • Testing of New Billing System Participated in development and implemented test plans, scripts, and scenarios for Milestone and System testing.
  • Documented testing through established IT resolution methods.
  • Served as primary user contact for Reporting and Transfer applications.
  • Assisted in the development of an automated regression environment to develop repeatable test results.
  • Implementation of New Billing System Specific responsibilities for test database maintenance, including editing, updating, saving and restoring data versions.
  • Presented demonstrations to users on various billing applications, including Management Inquiry, Transfers and Reporting applications.
- Team Leader
, , -
  • Responsible for daily task management, informal performance feedback evaluations, documentation, identifying and developing procedures, and training.
Administrative support, streamline, automation, Billing, Billing System, call center, Cash Receipts, Interpersonal Skills, client, Customer Service, Data Entry, data- entry, Data Modeling, database, documentation, editing, Information Technology, Insurance, legal, Access, access database, Excel, Office, Word, Presentations, problem analysis, Problem Solving, processes, progress, Project leader, project management, Quality, QA, Quality Control, Quality Assurance, Quest, Reporting, requirements gathering, Research, scripts, Six Sigma, software developers, technical support, Trainer, upgrades, workflow

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Resume Overview

School Attended

    Job Titles Held:

    • Customer Service and Insurance Operations Manager
    • Insurance Operations Manager Insurance Operations
    • Quality Control \ Project Manager
    • Billing Data Entry Manager
    • Missing Information Section Manager
    • Missing Information Section Manager
    • Billing System User Specialist
    • Team Leader


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