SUMMARY A position where my years of experience will be utilized in a creative and challenging environment that will help the company grow as well as myself. Seeking a company I can be proud to work for because of the ethics practiced throughout the company and within its community. SKILL & QUALIFICATIONS Over 15 years' of experience working in a Large Multi Facility Hospital business office Able to establish contacts with problem payers which assistance in expediting payment on claims processing Worked directly with senior management and key decision makers to develop strategies to resolve processing and reimbursement issues Able to read and understand Contracts to ensure proper claim payment ( per CPT, HCPC, ICD-10, Case rate, Per diems, Stoploss or RBRVS) Attended and contributed to provider and payer joint meetings on and office site Maintained a work queue with a variety policy types (HMO, PPO, POS, EPO Managed Medi-Cal & Indemnity) Prepared and submitted PDR forms, Retro Authorizations, Medical Necessity Disputes, Cap Deduct request, DMHC complaints and many other written requests to ensure the correct reimbursement EPIC Certified, familiar with Excel sheets, Word Documents, OneNote and other Microsoft programs to assistance with collecting information for report or when quantifying accounts for an accurate amount QUALIFICATIONS Over 15 years' of experience working in a Large Multi Facility Hospital business office Able to establish contacts with problem payers which assistance in expediting payment on claims processing Worked directly with senior management and key decision makers to develop strategies to resolve processing and reimbursement issues Able to read and understand Contracts to ensure proper claim payment ( per CPT, HCPC, ICD-10, Case rate, Per diems, Stoploss or RBRVS) Attended and contributed to provider and payer joint meetings on and office site Maintained a work queue with a variety policy types (HMO, PPO, POS, EPO Managed Medi-Cal & Indemnity) Prepared and submitted PDR forms, Retro Authorizations, Medical Necessity Disputes, Cap Deduct request, DMHC complaints and many other written requests to ensure the correct reimbursement EPIC Certified, familiar with Excel sheets, Word Documents, OneNote and other Microsoft programs to assistance with collecting information for report or when quantifying accounts for an accurate amount

Highlights:

• Contract review Rep.
• Appeals Rep.
• HMO,PPO MANG MCAL,
• ICD 10
• EPIC system certified
• A/R Management
• Medical collections
• Microsoft