Reimbursement Specialist/Office Manager Resume Example Company Name

REIMBURSEMENT SPECIALIST/OFFICE MANAGER

Summary

Dynamic and motivated professional with 15+ years of experience in healthcare administration. Proficient in tracking, appealing and resolving denied claims. Detail-oriented, multi-tasking with critical thinking and strong ability to identify, analyze and solve problems. Organized, versatile and able to work independently and in team environment.

Skills

Proficient in claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes
Proficient in Microsoft Office, Word, Excel, Power Point and Outlook
Excellent written and verbal communication skills
Solid research, analytical and problem-solving skills

Capability of working in fast-paced environment while meeting deadlines
Strong attention to details
Fluent in English, Russian and Ukrainian language

Experience

Reimbursement Specialist/Office Manager11/2000 to 08/2003Company NameCity, State

Collected and reviewed all patient insurance benefit information. Completed and submitted all necessary insurance forms in a timely manner as required by all third party payers for prior authorizations. Tracked and followed up on prior authorization request
Provided exceptional customer service to internal and external customers; resolved any customer requests in a timely and accurate manner; escalated complaints accordingly
Maintained frequent phone contact with provider representatives, third party customer service representatives, and pharmacy staff
Reported any reimbursement delays to employer/physician. Processed any necessary insurance/patient correspondence
Collected all necessary documentation required to expedite prior authorization request. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians
Exercised judgment within defined standard operating procedures to determine appropriate action
Performed related duties as assigned

Reimbursement Specialist08/2003 to 05/2006Company NameCity, State

Verified insurance eligibility and patient benefits to optimize reimbursement and customer satisfaction. Answered questions from the patients, clerical staff and insurance companies
Identified network providers, provider restrictions, and co-pays as needed. Maintained payer profiles by recording payer specific data promptly into the system
Obtained authorizations in a timely and correct manner. Ensured authorizations monitored for expirations/renewals
Prepared and submitted claims, followed up on claims, denials, payer correspondence and authorizations. Documented activities appropriately in progress notes
Managed A/R monthly and alerted manager about problem accounts (>60 days). Performed various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers
Monitored and updated Medicare, Medicaid and private payer policies and guidelines. Maintained the census

Appeals Specialist05/2006 to 02/2008Company NameCity, State

Reviewed assigned denials and EOB's for appeal filing information, gathered any missing information. Reviewed case history, payer history, and state requirements to determine appeal strategy. Obtained patient and/or physician consent and medical records when required by the insurance plan or state
Reviewed, analyzed and resubmitted denied claims, underpaid claims, and claims that are inaccurately processed
Created appeal letters with supporting documentation and mailed them. Worked to minimize third party payer denials
Monitored and followed up on appeals throughout entire process. Maintained accurate, clear, timely documentation related to denied cases. Identified billing-related issues and worked with payers, physicians and staff to resolve issues in a timely manner
Resolved denial and appeal complaints from patients, insurance companies and other offices for medical-related services
Responded to patient and family inquiries regarding denials. Acted as a patent advocate by identifying the path needed to obtain the maximum reimbursement under the insurance plan and work with the patient to get the denial overturned

Contract Specialist03/2008 to 07/2018Company NameCity, State

Created and built the third party payer contract agreements in the pharmacy operation system (CPR Plus). This includes creating insurance plans, researching and inputting business rules, and loading the contract pricing terms for implementation
Maintained assigned payer agreements. Updated and executed any changes to pricing, coding, or business rules
Worked with the Contracting and Revenue Cycle Management on site integration to insure proper insurance plans are accounted for, and assigned to the correct location
Identified contracts that are not generating revenue to see if there is an opportunity to purge records and reduce plan selection errors
Audited third party agreement pricing tables to ensure accuracy to improve Revenue Cycle Management success

Education and Training

Bachelor of Arts: Small Business Administration And Management1995International School of ManagementCity

Reimbursement Specialist: Medical Insurance Billing And Reimbursement2000Mildun Training Center of IllinoisCity

Resume Overview

School Attended

International School of Management
Mildun Training Center of Illinois

Job Titles Held:

Reimbursement Specialist/Office Manager
Reimbursement Specialist
Appeals Specialist
Contract Specialist

Degrees

Bachelor of Arts : Small Business Administration And Management 1995
Reimbursement Specialist : Medical Insurance Billing And Reimbursement 2000

Reimbursement Specialist/Office Manager Resume Example

Resume Score: 80%

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