Description
SUMMARY OF QUALIFICATIONS A highly skilled Medical Operational and Pharmacy Benefit Manager with expertise in oversight of Third Party Administrator processes and performance. A proven expert in auditing and recovery of overpayment claims which include Eligibility, Coordination of Benefits, Anesthesia, Assistant Surgeon, Co-Surgeon, Multiple Surgeries, and Contractual Agreement Discrepancies. Areas of expertise: Managing, Auditing, Negotiating and Recovering overpayments. Knowledgeable of State Law Insurance Regulations and our Government's Medicare compliance regulations. * Strong understanding of ICD coding, procedures, and guidelines. * System Proficiency: Acumen, Access, Rumba, ASD, OPT, MS Office: Excel (Pivot Tables), Word, and PowerPoint * Develops practical action plans to solve complex business problems * Builds outstanding teams and partners with the business to deliver business-focused solutions that embody innovative concepts * Highly organized top analytical skills knowledgeable of market place and conditions * An experienced trouble-shooter and problem solver develops extremely strong relationships of trust * Self-motivated with a no-nonsense approach to business works as an integral part of a team * Possesses excellent communication, interpersonal, and organizational skills
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