managed care collector resume example with 17+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
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Summary
Vibrant, Hard-Working and accomplished Managed Care Collection Specialist with 15 + years experience driving cash collections for Healthcare providers and insurance carriers. Posses knowledge of Medical terminology as well as ICD -9, CPT and HCPCS coding. Strong desire to grow in responsibility and experience within a structured organization that will motivate my ambition to broaden my horizons in the Healthcare industry.
Highlights
Conflict resolution
ICD-9 /CPT -4 Coding
UB-04 / HCFA 1500
Hospital & Physician billing
Relationship Building
Medical terminology
Patient Relations
Team player - Trainer
Experience
Managed Care Collector, 03/2009 to Current The University Of Kansas Hospital – Shawnee, KS,
Contact Healthcare providers regarding refund requests on overpaid Managed Care claims specializing in Coordination of Benefits request resulting from an audit on behalf of Aetna Insurance Company.
Comply with Federal and State Regulations and providers contract agreement to perform necessary authorized and unauthorized retractions from providers future payments on overpayment in compliance with Aetna guidelines.
Handle incoming calls from providers with questions and concerns regarding refund requests. Review providers contracts and explain the rules established by Medicare and by the (NAIC) National Associate of Insurance Commissioner for other group insurance payers on Coordination of Benefits claims.
Exceed department production goal of 40 provider calls per day.
Schedule and prepare agenda for monthly meeting with the Coordination of Benefits audit team to discuss questions and issues from the collection team. Collaborate with audit team on new refund concepts and give feedback on how to enhance refund explanation making request understandable to providers.
Receive written and verbal disputes and/or refund discrepancies from providers and forward to the audit team for review.
Establish and maintain positive business relationship with Business office staff to ensure fast and effective results in obtaining refunds.
Escalate provider settlement negotiation acknowledgment from providers to the Management Team to forward and follow-up with the client.
Recover over one million dollars in collection per month.
Patient Accounting Representative III, 09/2005 to 01/2008 21St Century Oncology – Fort Walton Beach, FL,
Conducted timely account receivable follow-up on Managed Care and Commercial recurring patient accounts for hospital services.
Completed follow-up on claims on timely basis according to the productivity guidelines and document account activities.
Reviewed system generated worklist, report and/or aged trail balance reports to resolve accounts that had been unpaid in the appropriate time frame based on specific third party payers contract and guidelines.
Identified trends in denials and tracked payment variances and promptly notified the Billing and Follow-up Supervisor and provided a root cause analysis and gave resolution information to resolve the issues.
Contacted Insurance carriers regarding underpayments to receive the correct payment.
Utilized insurance payers websites to check patient eligibility and claims status.
Handled credit balance management which included reviewed and resolved payment application errors and applied the correct contractual adjustments.
Reviewed denials and payment discrepancies identified through Explanation of Benefits, remittance advise and payers correspondences took the appropriate action to correct the accounts.
Billing Specialist , 01/2004 to 08/2005 Mercy Health System – City, STATE,
Handled timely billing and collection for physician services for four practices for all payers.
Contacted payers regarding underpayment to have claims reprocessed to receive the proper payments.
Requested paper HCFA-1500 claims forms to send secondary claims to payers for processing.
Performed outgoing and received incoming patients calls on updated insurance information, explained patient responsibility once insurance paid.
Reviewed overpayment reports and adjusted Medicare and Medicaid payments within 30 days of receipt.
Sent patient delinquent unpaid bills aged over 120 days to collection agency for handling.
Patient Accounting Representative III /Team Lead, 03/2002 to 01/2004 Siemens Medical Solution – City, STATE,
Handled timely billing and follow-up on accounts for Mercy Health System for physician services.
Investigated and resolved complex issues from the client, team and members.
Escalated issues to supervisor and Manager when encountered barrier to resolve the issues
Assisted supervisor in reviewing staff work and coordinated staff training and trained new hirers.
Mentored team members when production requirement were not being met and developed strategies to assist them to meet standards.
Worked special projects assigned by the Management staff
Analyzed system generated reports and identified payment discrepancies and researched root cause analysis of denials or non-payment to increase recoveries
Education
High School Diploma: Secretarial Studies, Expected in to William H Maxwell - Brooklyn, New York GPA:
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