Workers Compensation Administrator Resume Example
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WORKERS COMPENSATION ADMINISTRATOR
Professional Summary
Experienced workers compensation and facility safety administrator with excellent insurance and safety management skills. Action-oriented with strong ability to communicate effectively , extensive medical billing experience.
Core Qualifications
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Experience
Workers Compensation Administrator08/2006 to CurrentState Of North CarolinaKenansville , NC
- Solid background in the health care field, workers compensation management, medical billing, claim processing, account receivables, excellent customer service , clerical and communication skills, knowledge of computers and data entry, productive and efficient work habits, proficient in a variety of computer software.
- Coordinates and investigates and manage all workers compensation claims, manages legal counsel and third party administrator, manage and completes the evaluation of all workers compensation employee's, train and monitor new staff in the workers compensation department.
- Communicates with injured employee's, work closely with medical staff, monitor and manage workers compensation claims and expenses, Manages work restricted employees, time/attendance and work performance, oversee Hospitals return to work program for injured employee's, responsible for management of the workers' compensation division identifies exposures, recommends solutions, implements approved programs and promotes loss prevention.
- Facilitates claim processing, assist with the redirection of work versus non-work related claims, research information such as medical bills, restrictions, and medical provider notes, responsible for the timely filing of the OSHA 200 and 300 logs, and monitors workers' compensation plan through coordination with professional consultants and technical experts in the legal, medical, accounting, and financial disciplines, responsible for controlling/monitoring costs controls and managing medical aspect of each claim, approves cases to be forwarded to the rehabilitation counselor as needed, assist with making the determination to accept, delay or deny claims based upon valid medical factual or statutory review.
- Mitigates the organization's exposure to risk by developing, implementing and coordinating all claims related activities as well as resolving actual claims at the least possible cost.
- Helps determine probable monetary value of case and assigns appropriate reserve reviews reserves regularly to ensure adequacy, places injured employee with restrictions in modified positions until they are cleared to return to regular duty, writes light duty job Assess organizations department's periodically to participate in the light duty/return- to-work program.
- Chairs Employee Safety Committee and implements changes to organization based on workers compensation cost/injuries, completes employee safety inspection for all medical facilities,.
Medical Claims Examiner10/2004 to 08/2006KemperAuburn , IN
- Responsible for the coordination of all inpatient and outpatient workers compensation and commercial medical claims, management of all third party hospital accounts.
- Completes insurance verification, manages all workers compensation medical accounts for review and evaluation to determine reimbursement approval, determines eligibility for financial assistance programs and performs Insurance follow-up and customer Service, thoroughly investigates medical accounts billed to 3rd party payers, reviews in/out patient accounts per established criteria to determine level of follow-up activity necessary, supplies information necessary to ensure timely processing of claims.
- Thoroughly evaluates all incoming medical claims analyze and reviews accounts per established criteria to determine level of follow-up activity , adjusts accounts as necessary, responsible for processing complete and timely medical and employer workers compensation and medical facility claims, Thorough knowledge of CMS, Commercial and Worker's Compensation Insurance Billing procedures, excellent at handling multiple tasks.
Senior Medical Billing Coordinator09/2000 to 10/2004Harvard Medical Faculty Physicians At Beth
Israel Deaconess Medical CenterCity , STATE
- Responsible for the coordination and implementation of the billing and collections functions for the Hospitals Physician practice, adhere to prescribed policies and procedures on a daily basis to receive, review Edit and enter cpt / lcd-9 codes based on physicians documented services, register and verify all demographics on charge tickets, prior to submission to 3rd party payer, responsible for all hospital patient accounts and collection management of receivables and payments.
- Thorough knowledge of Medicare, Medicaid and managed care billing guidelines, responsible for the coordination and supervision of billing personnel at the hospitals eight satellite sites.
- Manages all incoming calls and complaints from Insurance payers and patients, interact with physicians from medical centers to adjust all Inaccurate claims for resubmission, successful in handling multiple projects.
Education
AMBA - General medical billing course - certification 03/1998 - 10/2000
* Medicare / Medicaid billing course06/1981Madison Park vocational Tech SchoolCity, State
Certificate of completion for course study.
* CWCP: Licensed Certified Workers Compensation Adjuster for the state of GA12/2003American Academy of Professional CodersCity
AIU Healthcare Management Bachelor Degree Studies - 2013
* CPAR Certified
Certified Patient Accounts Representative - Certification01/2006
Professional Affiliations
Claims Management Group
CWCP- Certified Workers Compensation Professional
Insurance Claims Professionals / Workers Compensation
Accomplishments
- Healthcare Financial Management Association / Georgia AMAC - Medical billing and coding training - 3/2003 Boston, Ma Computer Skills - Proficient in a variety of computer software Knowledge of CPT4 and ICD 9 coding through AAPC training Professional memberships AAPC, AMAC, AMBA, AHIMA, HFMA.
Skills
accounting, Billing, clerical, CMS, communication skills, counselor, cpt, excellent customer service, customer Service, data entry, lcd, Edit, filing, financial, Insurance, legal, loss prevention, notes, managing, medical billing, medical
billing, 2000, monitors, personnel, policies, research, Safety, supervision
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Resume Overview
School Attended
- Madison Park vocational Tech School
- American Academy of Professional Coders
Job Titles Held:
- Workers Compensation Administrator
- Medical Claims Examiner
- Senior Medical Billing Coordinator
Degrees
- AMBA - General medical billing course - certification 03/1998 - 10/2000
* Medicare / Medicaid billing course 06/1981
Certificate of completion for course study. * CWCP: Licensed Certified Workers Compensation Adjuster for the state of GA 12/2003
AIU Healthcare Management Bachelor Degree Studies - 2013 * CPAR Certified Certified Patient Accounts Representative - Certification 01/2006
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