SEARCH

Validator Liaison Resume Example

Resume Score: 85%

Love this resume?Build Your Own Now
VALIDATOR LIAISON
Professional Summary
Microsoft Office programs, Outlook, Excel, Word
CPT, HCPC, DRG, ICD9 Experience
Medicare and Medicaid experience
Medical Terminology
Coordination of Benefits experience
Policy Contract Experience 
Provider Contract Experience 
State and Federal Compliance Experience
Reimbursement policies Experience


Skills
Reviewing data claims for the purpose of overpayment analysis regarding but not limited to areas of duplicate payments, coordination of benefits, billing errors and contractual overpayments.Responsibilities also include researching within the clients system for areas of concern and areas of potential overpayments, or faulty billing practices.Internal teams testing new concepts, tracking and documenting test results to validate the implementation of new edits of data to produce approved concepts for production.Additional testing on new client implementations and special projects to ensure the maximum potential of system searches.As a Validation Liaison, I have a team of 5-10 employees for multiple clients, being the point of contact, for additional information and assistance to meet and exceed the client goals set forth on a monthly/yearly basis, some located within our home office and several which are in other locations.Development of materials and implementation of training of employees on various client processing systems.Supplying them with new hire and additional training when necessary and support through web-conferencing, screen sharing capabilities, and various other forms of communication.Interact with the external clients on a weekly basis for informative approval and clarification of concepts.Consistently achieving and exceeding personal monthly goals set per client, both in productivity and quality, while also working as a team to achieve a monthly team goal.Experience as a medical claims and life claims auditor, processing calculating and entering data according to individual policy provisions.Evaluate and respond to customer's written and telephone inquiries, incoming mail, electronic claims and agent inquiries, which resulted in the payment, denial, or referral of the claim.Processing of claim refunds and/or overpayments and adjustments to claims.Communicated between the client and the provider of services for completion
Work History
Validator Liaison 09/2006 to Current
West Asset Management Omaha, Ne – Omaha, Ne.
  • Currently working for a company as an outside vendor on behalf of multiple health insurance clients, processing overpayment identification and recovery.
  • Reviewing data claims for the purpose of overpayment analysis regarding but not limited to areas of duplicate payments, coordination of benefits, billing errors and contractual overpayments.
  • Responsibilities also include researching within the clients system for areas of concern and areas of potential overpayments, or faulty billing practices.
  • Internal teams testing new concepts, tracking and documenting test results to validate the implementation of new edits of data to produce approved concepts for production.
  • Additional testing on new client implementations and special projects to ensure the maximum potential of system searches.
  • As a Validation Liaison, I have a team of 5-10 employees for multiple clients, being the point of contact, for additional information and assistance to meet and exceed the client goals set forth on a monthly/yearly basis, some located within our home office and several which are in other locations.
  • Development of materials and implementation of training of employees on various client processing systems.
  • Supplying them with new hire and additional training when necessary and support through web-conferencing, screen sharing capabilities, and various other forms of communication.
  • Interact with the external clients on a weekly basis for informative approval and clarification of concepts.
  • Consistently achieving and exceeding personal monthly goals set per client, both in productivity and quality, while also working as a team to achieve a monthly team goal.

Microsoft Office programs, Outlook, Excel, Word  
CPT, HCPC, DRG, ICD9 Experience
Medicare and Medicaid experience         
Medical Terminology
Coordination of Benefits experience
LOMA (Life Office Management Assoc)
Policy Contract Experience         
ICA (International Claims Assoc.)
Provider contract experience 
State and Federal compliance experience
Reimbursement policies experience.
Senior Claims Examiner05/1995 to 08/2006
Physicians Mutual Ins Co – Omaha, NE
  • Experience as a medical claims and life claims auditor, processing calculating and entering data according to individual policy provisions.
  • Evaluate and respond to customer's written and telephone inquiries, incoming mail, electronic claims and agent inquiries, which resulted in the payment, denial, or referral of the claim.Processing of claim refunds and/or overpayments and adjustments to claims.
  • Communicated between the client and the provider of services for completion.

Microsoft Office programs, Outlook, Excel, Word
CPT, HCPC, DRG, ICD9 Experience
Medicare and Medicaid experience
Medical Terminology
Coordination of Benefits experience
Policy Contract Experience 
Provider Contract Experience 
State and Federal compliance Experience
Reimbursement policies experience
LOMA (Life Office Management Assoc
ICA (International Claims Assoc.
Education
High School Diploma: 1976Floyd Valley High School - Alton, Iowa
class course: ICA International Claims Assoc - Omaha, NE
class courses: LOMA (Life Office Management Assoc) - Omaha, NE
Skills
Benefits, billing, CPT, client, clients, forms, forth, home office, insurance, materials, Medical Terminology, Excel, mail, Microsoft Office programs, Outlook, Word, Office Management, policies, quality, researching, telephone, Validation, written
Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • West Asset Management Omaha, Ne
  • Physicians Mutual Ins Co

School Attended

  • Floyd Valley High School
  • ICA International Claims Assoc
  • LOMA (Life Office Management Assoc)

Job Titles Held:

  • Validator Liaison
  • Senior Claims Examiner

Degrees

  • High School Diploma : 1976
    class course :
    class courses :

Similar Resumes

View All
Liaison-resume-sample

Liaison

Wells Fargo

Charlotte, North Carolina