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Online Resumes with "DENIALS"



Family or General Practitioner - 11 Years of Experience - Near 40243

Duties:, and implement medical treatment for predominantly neuro/ orthopedic pts. Collaborated with neurosurgeon, medical advisor. Consult with doctors and other health-care providers about the circumstances that surrounded a medical situation gathering documentation in preparation for an approval denial or appeal for services based on policy provisions and medical necessity.

Tags for this Online Resume: Insurance, Compensation, Workers Compensation, Computer Aided Software Engineering, Consulting, Management, nurse practitioner, APRN

State Government - 20 Years of Experience - Near 60187

Experienced with SharePoint, Business Objects and E-Procurement systems to include Ariba, BuySpeed (Periscope) and CGI Advantage Financial software packages. * Review and approval/denial of requests based on budget and need. * Maintenance and auditing of procurement/financial files to ensure completeness and accuracy. * Audit and review of transactions with recommendations for further actions. * Expertise * Known expert pro...

Tags for this Online Resume: Purchasing, Training, Ariba, Buying, Catalogs, e-Commerce, Business Objects, Complaints, Filing, Information Technology

Home Health Aide

AREAS OF EXPERTISE * Medical Billing/Coding * Medical Billing Practice * Communication Procedures Ethics (Internal/External) * Medical Terminology * Patient Care & Interaction * Customer Service/Relations * Handling Confidential * Problem Solving * Document Management Information * Organizational Skills * Clerical Skills

Tags for this Online Resume: Accounts Payable, Accounts Receivable, Billing, CCU, Coding, Collection Processes, Customer Service, Document Management, Filing, Health Care Industry, medical secretarial, electronic medical records management, healthcare professional, data entry, obtaining prior authorizations, denial and appeal processes

Billing/Coding Specialist - 20 Years of Experience - Near 75167

PROFESSIONAL SUMMARY Over 25 years of Healthcare experience including: Coordination of the annual CPT/HCPCS adds/changes and deletions Maintaining the integrity of the Corporate Charge Description Master (CDM) Education of clinical staff on all annual changes that would impact their department for capture of billing Communication with Business Office to resolve claim rejections and/or denials Reinforcement of the CDM polici...

Tags for this Online Resume: Billing, CDM, Reviews, Accounting, Audit, Certified Pension Consultant, Health Care Industry, Medicare, Policies and Procedures, Pricing, Chargemaster, Revenue Integrity

Lawyer - 20 Years of Experience - Near 33323

CAREER SUMMARY 33 years in the practice of law from criminal defense to workers' compensation defense and mediation to general liability defense. Member of the Florida Bar and U.S. District Court for the Southern District of Florida since 1984. Trials of personal injury cases, all resulting in defense verdicts. Final hearings in workers' compensation cases with many favorable results including denials of benefits based on f...

Tags for this Online Resume: Defense, Insurance Defense, Litigation, Security, BAR, Benefits, Criminal Defense, personal injury, workers' compensation

Featured Profile

Administrative Services Manager - 19 Years of Experience - Near 22192

Susan M. Cooper 2835 Noble Fir Ct  Woodbridge, VA  22192  703.408.9406 (cell)  starpangle@aol.com Associates in Physical Therapy Dumfries, VA Administrator September 1998-June 2017 Billing Specialist July 2008-June 2017 Medical billing: • Billed approximately $3 million per year utilizing Medisoft billing systems (with a $1.5 million return). • Managed insurance contracting including Medicare, Anthem, Aetna, Blue...

Tags for this Online Resume: retail manager, store manager, assistant manager, sales, management, manager, Manager Administrator

Medical Office Manager - 6 Years of Experience - Near 62690

Customer service oriented professional who provides timely and accurate data to ensure reimbursement for patient services. Follows policies procedures and guidelines to assure consistent quality. Maintains and ensures patient privacy and confidentiality. Familiar with Microsoft Word Excel and PowerPoint Typing Speed: 34 words per minute. Manages time and prioritizes duties in fast-paced multi-task environments. Leads by exa...

Tags for this Online Resume: Customer Service, Payroll, Management, Medical, Medical Billing, Medical Records, Medical Terminology, Medicare, Accounts Receivable, Amazon Elastic MapReduce

Claims Examiner - 16 Years of Experience - Near 34613

QUALIFICATIONS I have been both Inside desk Adjusting/ File Reviewing (desk adjuster) and investigating insurance losses and Examining claims (CAT, daily & fraud-related) for app. 17 years and have a broad exposure to catastrophe & disputed losses (litigation also). I am BI-Lingual GA, have my passport, and licensed as a 2-15, 5-20 and 4-40 & General Commercial Adjuster (Citizens). Also licensed as an adjuster in app 20 sta...

Tags for this Online Resume: CAT, Settlements, Medical, Real Estate, Accounting, Audit, Fraud, Litigation, Insurance, insurance

Medical Claims Processor

Team player, fast learner, open to learn new things, HIPPA compliant,reliable,and detailed oriented.

Ideal Companies: The companies that I would love to work for is a sucessful, stable and a growing company.

Tags for this Online Resume: Healthcare Medical Billing, Clerical, Adminitration, Receptionist

Quality Coordinator

SUMMARY OF PROFESSIONAL QUALIFICATIONS: * Expertise in Medical Terminology, Legal Ethics, Coding insurance * Medical Billing and Coding Certificate * (ICD9-ICD 10) and knowledge of HIPAA privacy laws * Solid problem-solving and analytical skills * Knowledge of CMS 1500 form, and billing programs * Excellent interpersonal, communication and leadership skills * Highly motivated individual and team player * Professional with e...

Tags for this Online Resume: Customer Service z, Medical Terminology,, Medical Terminology ll, Medical Legal Issues,, Data Entry, Payroll, Accounts Receivable, Pbx, Receivables, Quality, healthcare

Featured Profile

Registered Nurse - 16 Years of Experience - Near 31707

Areas of Expertise Nursing * Disease Prevention * Health Promotion * Research & Analysis * History & Physical Exams Senior Care Managing, creating care plans for patients, involving appropriate state programs, primary care physicians, physician specialist, providers, care managers, patient, and their informational care givers * RN-Reviews submitted to state venders for determination of approval or denial for state services ...

Ideal Companies: State or Federal Nursing, Phoebe Putney Memorial Hospital

Tags for this Online Resume: Public Health, Assessments, HIV, Immunization, Cancer, Data Entry, Intensive Care, Inventory, Logistics, registered nurse, Case Management RN, Specialist, High Risk, Education, Coordinator, teamleader, computer programs, Communications

Billing/Coding Specialist

Summary of Qualifications: * CPAR Certification Received * Patient Advocate Experience * Knowledge of Pathology & Ambulance CPT codes * Knowledge of Hospital CPT codes * Work correspondence and insurance denials * Performed various Customer Service duties

Tags for this Online Resume: Insurance, Medicare, Benefits, Billing, Data Entry, Medical, Medical Billing, Pathology, Accounting, Customer Service