Marketing Manager resume example

• Manage daily operational activities of Reimbursement, appeals and Patient Assistance Programs in a call center environment
• Prepare and distribute reporting
• Design work flows; manage productivity volumes
• Develop and deliver training to ensure each team member maintains a high level of attention to detail
• Perform audits and provide constructive feedback and suggestions for program improvements
• Deliver corrective actions, develop performance improvement plans and conduct employee performance reviews.
• Process bi-weekly payroll for all direct reports
• Coordinate annual new hire training initiatives
• Represent company in client meetings and report operational trends and metrics

• Perform pre-pay and post-pay workman's compensation medical claim review and make medical determinations and coverage decisions and payment recommendations in accordance with published practices, policies and procedures for each state of jurisdiction
• Ensure claims are filed with proper documentation and are free of potential non-coverage misrepresentations or fraud
• Respond to clients and providers with issues and concerns regarding medical review

• Responded to 12 incoming phone lines for group of seven physicians Scheduled appointments for 150+ patients weekly.
• Acted as primary contact between physician clients and billing office, Verified insurance coverage, collected co-pays and obtained orders and referrals prior to scheduled services.
• Coded and transcribed written diagnosis into ICD-9 format.

•Generated private insurance, HMO, PPO, Medicaid and Medicare billing claims for a 15-physician practice.

•Interacted with carriers such as Coventry, United Healthcare, Aetna and Family Health Partners.

•Resolved denials, credit balances and credentialing issues.

•Posted cash applications, entered charges and discussed billing issues with patients, doctors and insurance providers.

• Supported billing and collections for an 80+ bed inpatient and outpatient facility
• Interacted with insurance companies, case managers, patients and families in reviewing insurance verification for services
• Estimated reimbursement by third-party payers, prorated accounts and calculated contractual allowances for inpatient/outpatient claims