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managed care supervisor resume example with 14+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Professional Summary

Highly skilled and enthusiastic professional with 17 years experience in Health Care (DME) Detail-orientated leader with the ability to successfully oversee the revenue cycle. Highly organized with excellent communication and time management skills. Enjoys creative problem-solving, team collaboration, skilled in working under pressure, and is a dedicated employee with uncompromised integrity. Worked with various Managed Care entities with extensive knowledge of DOFR's, carve outs, and capitation. Motivated to learn, grow, and expand my knowledge and skills.

Skills
  • ICD-10; HCPC codes
  • Medical Terminology
  • Medical billing requirements and procedures
  • Collection Management; Accounts Receivable
  • Managed Care, Medi-Cal, and Medicare
  • MestaMed, HDMS, Redbook, McKesson, Insurance portals, Microsoft, HCFA-1500
  • Multi-Tasking
  • Decision -making
  • Relationship and Team building
  • Training and mentoring
Work History
Managed Care Supervisor, 12/2013 - 07/2020
Cvs Health Lewiston, ME,
  • Managed team of 1 lead and 6 collectors
  • Structures and organizes work assignments of staff to ensure all billing is handled appropriately
  • Ensures work assignments are completed accurately, efficiently, and timely
  • Ensures team and individual bench marks are achieved (executing goals through effective communication, problem solving, and efficient processes)
  • Reviews work routinely to ensure accuracy to maximize cash flow
  • Provide coaching and feedback to staff
  • Direct hands on training
  • Generates and analyzes reports to identify areas of focus and trends in revenue
  • Communicates payer issues and solutions to upper Management and outsource team {PROCHANT}
  • Research patient accounts thoroughly and responds accordingly to patient inquiries/account status.
  • Collector audits conducted weekly and training if needed
  • Weekly one on one meeting with manager
  • Monthly one on one meeting with lead and collectors
  • Conducted weekly team and lead meetings
  • Approved/Denied adjustments, refunds, and appeals
  • Submitted table/system corrections
  • Implemented employee awards and acknowledgment for staff
  • Created and implemented SOP's
  • Quarterly presentations with Billing Management, CFO, and CEO
  • Responsible for hiring, coaching, performance reviews, and discipline of subordinate staff
  • Complies with and adheres to all regulatory HIPAA compliance policies and procedures
  • Payers assigned; L.A . Care, Aetna, Health Net, SCAN, Caremore, PPO's, LOA's (Capitation and FFS) AHMC, SRS, SCRIPPS, Hemet, Health Care Partners
  • Bonus Goals achieved
Managed Care Lead, 01/2011 - 11/2013
Avalon Health Care Group Bountiful, UT,
  • Generated aging reports for collectors
  • Audited collectors weekly
  • Assisted Supervisor with emails/questions from team, different departments, and outside entities
  • Assigned weekly reporting/stats to Supervisor
  • Assigned various reports (convert to loss; patient deceased)
  • Completed daily exception/rejection reports via HDMS and Office Ally (correcting DOB, Diagnosis, CMN's, modifiers, updating PCP information)
  • Posted payments or transferred payments to correct payer
  • Corrected prior authorizations/CMN's in system
  • Completed high dollar accounts
  • Assisted with denials and payer changes
  • Assisted with confirming orders at month end when needed
  • Submitted table/system corrections
  • Trained interns and new employees to department
  • Recognized for Employee of the month
Special Projects Collector, 01/2008 - 12/2010
SuperCare Health City, STATE,
  • This department was specifically designed for high level collectors to analyze and focus on problematic payers, issues, and trends, while given direct contact with appropriate entity.
  • Assigned Managed care payers; however assisted with Medi-cal and Medicare
  • Completed daily exception/rejection reports via HDMS and Office Ally (correcting DOB, Diagnosis, CMN's, modifiers, updating PCP information)
  • Experienced in Parenteral and Enteral Nutrition calculations (AWP, Medi-cal, Medicare) Familiar with respiratory meds
  • Submitted table/system corrections
  • Trained interns and new employees to department
  • Received "Caught in the Act of Caring" award
Managed Care Collector, 09/2005 - 12/2007
SuperCare Health City, STATE,
  • Orchestrated day-to-day operations of billing department, including medical coding, accounts receivables, and collections.
  • Prevented financial delinquencies by working closely with lead and Supervisor to resolve billing issues before becoming unmanageable.
  • Filed and updated patient information and medical records.
  • Reviewed patient records and medical documentation for equipment validation.
  • Communicated with insurance providers to resolve denied claims, resubmissions, and appeal status.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Verified eligibility and benefits via phone and online.
  • Submitted timely and accurate charge submissions.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Requested for initial/modified/reoccurring authorizations to appropriate team.
  • Ensured payment accuracy with contracts and fee schedules.
  • Submitted corrected claims and written appeals (hardcopy and electronically)
  • Requested adjustments and refunds to Supervisor.
  • Resolve billing call inquiries from patients
  • Prepared billing statements for patients and collected financial obligations.
  • Complies with and adheres to all regulatory PHI and HIPAA compliance policies and procedures.
  • Cash Collections; Maintained over 90% collection goal; Highest collection goal achieved 137%.
Medical Insurance Biller, 01/2003 - 08/2005
PSP Medical City, STATE,
  • Filed and updated patient information and medical records.
  • Reviewed patient charts to better understand health histories, diagnoses and treatments.
  • Verified signatures and checked medical documentation for accuracy and completion.
  • Verified eligibility and benefits via phone.
  • Reviewed insurance company denials/EOB's.
  • Communicated with insurance providers to resolve denied claims, follow up's, and appeal status.
  • Submitted PDR's and corrected claims for proper and timely reimbursement.
  • Responded to customer concerns and questions on daily basis.
  • Adhered to established standards to safeguard all patients' health information.
Education
Certificate: Medical Insurance Biller, Expected in 10/2002
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Bryman College - Whittier, CA,
GPA:
Status -
High School Diploma: , Expected in 06/1998
-
Bishop Amat High School - La Puente, CA,
GPA:
Status -

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Resume Overview

School Attended

  • Bryman College
  • Bishop Amat High School

Job Titles Held:

  • Managed Care Supervisor
  • Managed Care Lead
  • Special Projects Collector
  • Managed Care Collector
  • Medical Insurance Biller

Degrees

  • Certificate
  • High School Diploma

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