SUMMARY:

• Case Manager and Program Specialist with a MBA and a strong background in all aspects of medical case management field.
• A proven passion for assisting others demonstrated by a vast number of satisfied clients.
• Excellent track record for motivating and driving a successful team through the use of collaborative technical and leadership skills.
• Expertise in the consumer insurance industry and driving sales through years of experience.
• Experience interpreting and applying federal laws and regulations such as, but not limited to, HIPPA, complaints and appeals, and Medical necessity.
• Skilled in customer service and customer satisfaction. Actively listens to customers to determine their needs and problems. Works quickly to resolve all issues.
• Adept at claims management activities.
• Experienced in dealing with multiple third party billing companies at once.
• Experience in preparing reports for inquiries regarding healthcare programs. (e.g. Medicare, Medicaid, etc.)
• Excellent interpersonal skills to foster and fortify partnerships with new business contacts and industry professionals.
• Strong negotiating, mathematical, analytical and organizational skills.

COMPUTER SOFTWARE:

MS Office Suite including Word/Excel/PowerPoint/Outlook (advanced)

PROFESSIONAL EXPERIENCE:

Confidential, MD

Real Estate Wholesaler

Responsibilities:

• Qualifying and generating leads by analyzing properties and negotiating contracts based on buying guidelines.
• Research probate leads by visiting the courthouse to find the personal representative of the estate and contact owners to see if they are interesting in selling their vacant properties.
• Utilize various websites to investigate property details such as taxes owed, appraisal, wills, deeds, etc. (e.g. BidBaltimore.com, Department of Assessments and Taxation, MDlandrec.com, Zillow.com, real estate agent assistant, etc.)
• Utilize a variety of marketing techniques. (e.g. Internet marketing, direct mail marketing, business cards, flyers, etc.)
• Network with real estate agents, real estate investors, title companies, contractors, and appraisers.

Confidential, Rockville, MD

Senior Reimbursement Counselor/Case Manager

Responsibilities:

• Served as subject matter expert for the operations of the program.
• Reviewed medical requisitions received from physicians to determine the specifics of the request.
• Routed the requests to the appropriate department or responded to the requests quickly.
• Provided information requested as expeditiously as possible.
• Once medical requisitions were entered into the database, a cross checking - mechanisms was performed to determine if any data was missing or inaccurate.
• Utilized a credentialing database to confirm prescribing physician’s national provider identifier number.
• Conducted a benefits verification of patient insurances from a variety of sources in order to complete the billing, prior authorization, appeals, and/or cash processes
• Provided counseling and case management to physicians, nurses, and consumers about the benefit coverage of the product being order and the manufactures guidelines by phone, fax, and mail. (e.g. consumers age requirements, diagnosis, side effects, consumers out of pocket cost, etc.)
• Evaluated claim denials using Federal policy analysis, reported, and communicated both oral and written any reimbursement trends/delays (e.g. billing denials, claim denials, pricing errors, payments, etc.)
• Advocated for patients by connecting them to nonprofit organizations and followed up weekly to determine if customers followed through and/or received the financial services for which they applied for.
• Maintained frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
• Provided world class customer service to all clients. Listened and understood their concerns and problems before responding. Determined the best course of action to accurately and swiftly resolve their issues.
• Respected client confidentiality in regards to all medical and billing records. Maintained this level of confidentiality with providers, only providing them with critical information about a denied claim.
• Worked on problems of diverse scope where analysis of data required evaluation of identifiable factors. Demonstrated good judgment in selection methods and techniques for obtaining solutions.
• Used an automated data processing system to accomplish a wide range of clerical and data entry/retrieval tasks in support of administrative work.
• Provided training and support to inter-departmental associates.

Confidential, Rockville, MD

Data Collector

Responsibilities:

• Conducted telephone surveys through an approved list of contacts. Interviewed the contact based on a specific list of questions that usually included their name, address, age or state of residency.
• Identified problems with data inaccuracy. Reported these problems to the appropriate resource in order to correct errors. Explained survey objectives after data verification was complete.
• Complied all responses for the surveys in a database application. Coded the results of the survey so they were easily searchable in the database.
• Quickly resolved inconsistencies in data in order to provide the most accurate data analysis for auto-generated reports. Fixed errors on the spot in order to avoid major inaccuracies at a later date or interview.

Confidential, Rockville, MD

Reimbursement Counselor

Responsibilities:

• Collected and reviewed patient insurance benefit information.
• Provided assistance to the physician office staff as well as to patients that needed to complete paperwork and necessary forms.
• Electronically submitted insurance information in a timely manner to ensure payment by third party payers.
• Followed all guidelines and requirements set forth by the insurance industry and third party billing companies.
• Utilized various mediums for collections including: fax, mail and email.
• Report any reimbursement trends to the on duty supervisor for quick analysis.

Confidential, Rockville, MD

Program Specialist

Responsibilities:

• Streamlined a database that housed patient and physician accounts. Optimized data storage in order to reduce administrative work and processing times.
• Researched insurance coverage for clients to ensure they were being billed fairly.
• Accurately and quickly submitted claims disputes to reduce the cost out of pocket for the client.
• Championed a mass data entry of all written records to transfer them over to electronic records.
• Trained all administrative staff so they were easily able to access records.
• Facilitated open and honest communication between departments.
• Decreased problem resolution time by fostering open relationships based on trust and honesty.