Rac Appeal Coordinator resume example with 20+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • 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.

  • Drug storage procedures
  • Staff Development
  • New Hire Onboarding
  • Updating medication histories
  • Excellent math skills
  • Outstanding interpersonal abilities
  • Pharmacy and customer records management
  • Team collaboration
  • Great team player
  • Receiving incoming supplies
  • Confidentiality and HIPAA
  • Drug inventory management
  • Assisting pharmacists
  • Processing payments
  • Excellent Customer Service
Work History
RAC Appeal Coordinator, 02/2012 - 10/2020
Healthpoint Tukwila, WA,
  • 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.
Associate of Science: Pre-Medicine, Expected in
Oakland Community College - Bloomfield Hills, MI

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Resume Overview

School Attended

  • Oakland Community College

Job Titles Held:

  • RAC Appeal Coordinator
  • Pharmacy Technician Trainee
  • Medical Biller/Owner/Operator
  • Office Manger/Trainer/Biller & Compliance


  • Associate of Science

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