Description
SUMMARY OF QUALIFICATIONS Proactive in Healthcare Industry with 20 + years of trained expertise in various facets and knowledge of Medicare, Medicaid, Major Medical, Workers Compensation, Auto and Third Party Billing, extensive knowledge of CPT, ICD9, HCPC coding nomenclature and Medical Terminology, pre-certification and prior authorizations. Proficient in Microsoft Word, Internet research, Excel, Mysis, Vision PM, Vision Optimum, MS windows, Nextgen. Excellent communication with all levels of management and interpersonal skills. Created and implemented new ideas to increase cash collections and cash flow, collected payments, reduced and resolved multiple member accounts over $20k-$50k, leadership role of teaching and responding to colleagues based on insurance regulations and policy questions, developed and demonstrated a presentation for coordination of benefits to save the company money by minimizing refund request. Researched member eligibility and benefits for clean claim submission and eliminated untimely filing, collected vital documentation that was relevant to appeals that supported medical necessary and collected the highest benefit level of payment. Accomplished and negotiated pricing with insurance companies on extensive surgical procedure for the Surgeon, Assistance Surgeon and the Anesthesiologist in a teaching setting hospital, HIPPA compliance, maintained thorough knowledge of all healthcare plans guidelines and protocol for payment. (Third Party Billing Company contracted with out of state hospital)
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