Rac Appeal Coordinator resume example with 20+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Professional Summary
I am an enthusiastic, hard-working individual eager to contribute to team success through attention to detail and excellent organizational skills. I have worked as a Pharmacy Technician in Training and was successful in quickly and accurately filling prescription orders and building relationships with customers for sustained business growth and customer retention. I maintain a flexible schedule, adapt to unique business and customer needs and have an in-depth knowledge of medical terminology, pharmaceutical storage and inventory management.
Completed in-depth investigations into issues pertaining to insurance denials, grievance management and recommended strategies.
Educated case managers and physicians on contract procedures, administration and interpretation.
Resolved insurance problems, improved operations and provided exceptional client support.
Worked with hospital facilities to understand needs and provide audit service, as well as communication with insurance carriers.
Managed quality assurance program, including on-site evaluations regarding processes and internal audits.
Maintained excellent attendance record, consistently arriving to work on time.
Drove operational improvements which resulted in savings and improved profit margins for hospital facilities.
Led a case management team in delivery of insurance audit projects, resulting in money recuperated by the hospital facilities.
Resolved conflicts and negotiated mutually beneficial agreements between parties.
Developed team communications and information for hospital, insurance and team meetings.
Developed team communications and information for Law Judge hearings in the court system.
Pharmacy Technician Trainee, 12/2015 - 11/2016 Kroger – City, STATE,
Provided expertise about composition of drugs.
Assisted with filling of over 100 prescriptions daily.
Counted, measured, and compounded medications following standard procedures.
Communicated with prescribers to verify medication dosages, refill authorizations and patient information.
Maintained proper drug storage procedures, registries, and records for controlled drugs.
Located and measured medications according to prescription information, making modifications as instructed by pharmacists and providers.
Collected co-payments or full payments from customers.
Answered incoming phone calls and addressed questions from customers and healthcare providers.
Resolved non-routine issues like third-party billing, computer system and customer service issues.
Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
Aided customers in understanding how to properly take medications.
Reviewed and verified customer information and insurance provider information.
Assisted patients in minimizing medical expenses by recommending generic alternative prescription medications.
Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
Reduced supply shortages by carefully monitoring inventory and submitting replenishment orders before depletion.
Developed and implemented improvements to pharmacy organization system.
Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems and locating items.
Stocked, labeled and inventoried medication to keep accurate records.
Managed opening and closing duties for pharmacy, such as pulling refill information off of the phone system and faxed prescriptions from computer system.
Processed over 100 prescriptions per day in busy pharmacy achieving decreased customer wait times and maintaining excellent customer satisfaction.
Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
Implemented vaccine awareness campaign that increased immunization-based revenue and enhanced community health education.
Verified patient data and billing information to discover and resolve erroneous bills due to system errors.
Resolved non-routine issues like third party billing, computer system and customer service issues.
Welcomed customers to pharmacy and answered questions relating to prescriptions and over-the-counter products.
Coordinated with physicians and insurance agency representatives for speedy resolution of prescription discrepancies.
Set up and modified patient profiles in the Kroger software to include current information such as medications and insurance details.
Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
Precisely measured and combined ingredients to deliver scrupulous formulation on customer compound prescription orders.
Liaised with other pharmacies to eliminate issues related to product expiration.
Performed various pharmacy operational activities with strong commitment to accuracy, efficiency and service quality.
Generated prescription labels using Kroger software, verifying accuracy of patient and medication information.
Prepared packaging and labels for prescriptions, verifying accuracy of dosage, side effects, interactions and refill instructions.
Medical Biller/Owner/Operator, 07/2006 - 07/2009 CPC Billing, LLC – City, STATE,
Communicated with insurance providers to resolve any denied claims and resubmit.
Verified signatures and checked medical charts for accuracy and completion.
Applied charges and updated patient records by using proprietary software.
Maintained current accounts through aged revenue reporting.
Liaised between patients, insurance companies and billing office.
Orchestrated day-to-day operations of billing department, including medical coding, payment posting, accounts receivables and collections.
Enforced operational compliance with state and federal laws and JCAHO standards.
Guarded against fraud and abuse by verifying all coded data accurately reflected services provided.
Collected payments and applied to patient accounts.
Gathered information from multiple sources to simplify billing and organize accounts.
Reviewed patient records, identified medical codes and created invoices for billing purposes.
Posted charges, payments and write-ups for cardiovascular procedures.
Participated in workshops and other training opportunities to remain current on billing procedures, regulations and industry updates.
Prepared billing statements for patients and verified correct diagnostic coding.
Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments.
Devised new methods to make workflows more efficient.
Followed up on legal claims.
Confirmed backup and proper storage of sensitive information in event of data breach or outage.
Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
Reviewed patient diagnosis codes to verify accuracy and completeness.
Analyzed medical records to satisfy insurance company mandates.
Adhered to established standards to safeguard all patients' health information.
Delivered timely and accurate charge submissions.
Researched and followed up on denied insurance claims.
Complied with all HIPAA Privacy and Security Regulations to protect patients' medical records and information.
Trained new employees on multiple medical billing programs and data entry software.
Managed billing calendar and scheduled claims for payments.
Efficiently collected payments and communicated with clients.
Posted payments and collections on regular basis.
Transferred balances to correct payers.
Reviewed outgoing bills for eligibility and accurateness.
Tutored new coders for compliance with insurance and Federal guidelines, as well as coding guidelines.
Reviewed medical records per day to select appropriate coding sequences.
Verified proper ICD-9 coding on claims.
Translated and interpreted medical billing codes with strong accuracy to enable swift payment from insurance agencies.
Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Office Manger/Trainer/Biller & Compliance, 12/1997 - 07/2006 Michigan Hospitalists, PC – City, STATE,
Liaised with patients and addressed inquiries and billing questions.
Improved office operations by automating client correspondence, record tracking and data communications.
Enhanced collaboration between team members by preparing meeting materials and taking clear notes to distribute to stakeholders.
Integrated logistic systems into company processes to improve operations and manage work orders and price changes.
Established and developed highly efficient and dependable administrative team by delivering ongoing coaching and motivation and fostering career advancement.
Established efficient workflow processes, monitored daily productivity and implemented modifications to improve overall effectiveness of personnel and activities.
Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
Assisted with creation of database for use by staff and physicians, including troubleshooting, maintenance, updates and report generation.
Handled all incoming business and client requests for information.
Compared vendor prices and negotiated for optimal savings.
Performed billing, collection and reporting functions for office generating over one million dollars annually.
Communicated corporate objectives across all divisions through regular correspondence and scheduled status updates.
Arranged corporate and office conferences for company employees.
Handled new-hire orientation and basic recruiting tasks for best-in-class talent identification.
Secured optimal program efficiency through collaboration with internal teams and development of positive community relationships.
Solved problems timely and effectively, ensuring customer satisfaction.
Evaluated employee records and productivity to complete over 100 employee evaluations per quarter
Recruited, hired, trained and supervised staff of 100+ and implemented mentoring program that offered positive employee engagement.
Streamlined office operations by computerizing activities, managing customer communications, scheduling payments and tracking records and documents.
Developed and implemented office management procedures, increasing training efficiency, team productivity and accuracy.
Coordinated special projects and managed schedules.
Managed 100+ employee Hospitalists group, billing office, compliance team, supervising workers and enhancing productivity and efficiency.
Maintained computer and physical filing systems.
Met challenging quotas for productivity and accuracy of work.
Prepared vendor invoices and processed incoming payments.
Recruited and hired qualified candidates for vacant and new positions.
Coordinated individual duties after careful evaluation of each medical billers skill level and knowledge, which increased productivity by 100%.
Organized and facilitated Physicians and Physician Assistants, head meetings weekly, discussing current census, admissions and discharges and hospital issues.
Conducted routine facility charting inspections, identifying areas needing improvement, training Physicians and PA's for continued compliance with associated regulations.
Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
Implemented best practice standards for billing resulting in substantial reduction of accounts receivable delays.
Education
Associate of Science: Pre-Medicine, Expected in - Oakland Community College - Bloomfield Hills, MI GPA:
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