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Online Resumes with "claim appeals"
Physician executive strong CM/UM experience, demonstrated ability to avoid readmission and increase claims efficiance - near 60637/430
Experienced medical professional, expert in adult and geriatric medicine, care coordination that avoids unnecessary readmission,chronic disease management (including home visits,) Medicare, it's managed care partners and dual eligible,managed care administration, medical education, and clinical practice. Committed to empowering providers and utilization/care management nurses to fully partner with payors and health systems ...
Ideal Companies: BlueCross/BlueShield, Medicare, Anthem, Cigna, United Health Care, CMS, Presence, Valence
Tags for this Online Resume: Geriatrics, Chronic disease management, Utilization/Care Management, HIPAA/Clinical Medical Ethics, HealthCare Professional Education, clinical policy development, Physician, Director, Medical Director, Physician Executive, Adult Medicine, Geriatric Medicine, Care Coordination, Population Health, Dual Eligibility Systems, Risk Management, Medical Education, Multidisciplinary Education, Clinical Ethics Training, Medical Ethics, Oral Communication, Written Communication, Social Media, MS Office, MD, FACP, AGSF, Underwriting, Claims, Non Profit, Principle
Operations Manager
I am organized, flexible, dynamic, ambitious, goal oriented individual with an extensive background in victim advocate, office management, human resources, employee relations and Operations management. Subject matter expert who enjoys learning and executing new procedures, programs and processes. A dynamic team player very attentive to detail and produces quality results. Aiming to work in an organization that offers profes...
Ideal Companies: climber.com
Tags for this Online Resume: Administration, Customer Service, Management, Payroll, Recruiting, QuickBooks, Compliance, MS Office, Complaints, Documentation
Market Conduct, Compliance, Medical Claims, Appeals - 16 Years of Experience - Near 53154
CAREER SUMMARY Dedicated health insurance professional with more than 16 years of experience in Claims Operations, Market Conduct and Regulatory Compliance along with Underwriting. Advanced skills in analyzing data and implementing improvements that enhance operations. A proven innovator in obtaining results with an acute attention to detail. Skills and abilities include: Project leadership, Medical terminology, Regulation ...
Tags for this Online Resume: Project Leader, Medical Records, Risk Assessment, Underwriter, Appeals, Grievances, Critical Thinking, Milwaukee, Microsoft Office, Insurance, Medical
Human Resources Manager
Accomplishments * Strategically formulated the human resources plans to 100% align with the organization's vision and mission plan * Increased district retention rates by 2% each year by implementing responsive human resources services. * Presented over 50 adult training sessions with 90% positive survey responses. * Resolved 95% of employee relation conflicts saving the district over $500,00 by utilizing positive communica...
Tags for this Online Resume: Benefits, Budgeting, Business Development, Coaching, Communication Systems, Communications, Compensation, Consulting, Employee Relations, Human Resources
Insurance Underwriter
SUMMARY Underwriting professional with over 30 years experience in Individual, small group, large group and Life insurance. I am looking forward to continuing my insurance career or expanding into a career that my experience lends its self to such as claims, mortgage, P & C or managerial either in an office or remote setting. ACCOMPLISHMENTS * Boosted customer service and departmental goals by developing new processes and i...
Tags for this Online Resume: Underwriting, Insurance, Complaints, Medical, Underwriter, Medical Records, Life Insurance, Risk Assessment, C Programming Language, Customer Service
Federal Government - 20 Years of Experience - Near 60544
Managed Responsible for the solicitation, negotiation, administration, close-out, and termination of purchase orders and contracts using procedures outlined in the Federal Acquisition Regulations, VA Acquisition Regulations, Public Laws, and Agency policy. Develop, implement, and review contracting plans for pre-award, post-award, price/cost analysis and a wide variety of procurement activities. Responsible for recommending...
Tags for this Online Resume: Procurement, Acquisitions, Contracting, Documentation, ECMS, Market Research, Research, Planning, Solicitations, Architectural, Negotiations, Contract Administration
Director - 15 Years of Experience - Near 19438
QUALIFICATIONS SUMMARY Highly motivated healthcare insurance professional with 30+ years of management experience in the healthcare payer arena. Extensive background in healthcare operations, specifically claims, appeals, precertification, healthy lifestyles, case management and call centers. Candidate with proven record of exceeding management goals, implementing performance objectives and process improvements beyond expec...
Tags for this Online Resume: Home Health, Computer Aided Software Engineering, Customer Service, Inventory, Managed Care, Management, Inventory management, PEDIATRIC, Benefits, Blue Prints
Billing/Coding Specialist - 15 Years of Experience - Near 01571
Summary I would like to offer services for practices or facilities that are need of assistance. I would be willing to work remotely as I do not wish to leave my current practices. I am the Director of Billing for three multi-specialty medical groups for the past 11 years. These practices specialize in Internal Medicine, Infectious Disease, Sports Medicine and Gastroenterology. I've been a requested consultant for numerous s...
Tags for this Online Resume: Billing, Medical, Accounting, Accounting Functions, Amazon Elastic MapReduce, Attention to Detail, Balance, Coding, CT, Database
Senior Manager, Claims and Contract - 20+ Years of Experience - Near 03051
Over 23 years of knowledge and expertise in Managed Care Medicare, Medicaid and Commercial with a concentration in claims, appeals and customer service.
Tags for this Online Resume: Inventory, Services, Support, Management, Risk Assessment, Benefits, Information Technology, Leadership, Managed Care, Medicare, healthcare
Compliance Officer
QUALIFICATIONS SUMMARY Highly motivated healthcare insurance professional with 30+ years of management experience in the healthcare payer arena. Extensive background in healthcare operations, specifically claims, appeals, precertification, healthy lifestyles, case management and call centers. Candidate with proven record of exceeding management goals, implementing performance objectives and process improvements beyond expec...
Tags for this Online Resume: Home Health, Customer Service, Inventory, Managed Care, Management, Computer Aided Software Engineering, Inventory management, PEDIATRIC, Medicare, Pre-certifications
Excellent insurance sales experience with the constant balance of underwriting (company) and service (client).
My career objective is to obtain financial position within either the Insurance or the Banking industries offering a full-time, direct employee position. I welcome responsibly and have experience managing each market to operate at full staff capacity; a proven record of achieve or exceed business goals.
Ideal Companies: USAA, Amica Insurance, Allstate Insurance, Wells Fargo, UnitedHealth Group, BB&T, Bank o America, & ect...
Tags for this Online Resume: analyze risk, profitability, retention, counseling borrowers, advanced verbal and written communication skills, relationship-building skills, marketing, integrity, manager experience, proven sales experence
Admissions Director - 17 Years of Experience - Near 90044
Seeking a leading position as a healthcare manager in a progressive healthcare company where I can work as a part of an organization to lead and communicate efficient quality-driven skills.
Ideal Companies: The University of Southern California, University of Irvine, Alta Med, Davita Medical, Providence Health, Bank of the West, Prospect Medical, University of Los Angeles, Medtronic, and Pharmaceuticals organizations
Tags for this Online Resume: Insurance, Management, Medical, Process Assessment, Billing, ERISA, Health Insurance, Health Insurance Portability And Accountability Act, Referrals, Security, compliance, auditing, analyst, profits, revenue cycle, reimbursement, EMR, EHR, EPIC, Cosmos, Leadership, Implementation, Process Improvement, NCQA, Medicare, Third Party Insurance, Workers Comp, Government, Financial, Finance, SQL, administration, coding, medicaid, medi-cal
