Summary Of Qualifications Claims Team Supervisor with strong extensive experience in claims processing. I handled 30-35 examiner in a team. Responsible for Claims Processing, managing Medicare/Medicaid and Commercial insurances, capitation HMO, PPO. Responsible for non-cover claim to support staff for issuance of appropriate denial letters and/or referral to HMO. Responsible for following up on commercial and managed care claims reconciliation and resolution or appeals. Responsible for verified patient eligibility, benefits, patient/insurance liability to pay and payment responsibility. Responsible for negotiating disputed claims to obtain a mutually satisfactory settlement of collections. Responsible for training patients, physicians and staff in HMO and PPO protocols and benefits. Travels to several sites as a Supervisor/Manager. Accomplishments OPERATIONS * Developed and managed a plan that reduced overtime by 75% by working a team of individuals on strategies to curb the use of overtime. * Introduced the first Safety Fair by managing the material delivery from internal departments as well as outside partners, clients and vendors to ensure product delivery objectives and timelines were met or exceeded. * Introduced the new Systems of Safety training to the Appointment and Advice Call Center. * Responsible for setting strategic direction of projects and developing project plans. * Provides human resources support including managing the hiring, salary determination and competency assessment processes. * Coordinates multiple projects, orchestrates meetings, and develops timelines. * Ensures projects are completed on schedule following established procedures and schedules. * Promotes a team environment and provides work direction and guidance including coaching, professional development and training. * Resolves grievances.

Highlights:

• Budgetary
• Complaints
• Policies and Procedures
• ADA
• Ada Programming Language
• Team Player
• Facilitator
• HR
• Human Resources
• Management
• call center