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Case Management Specialist Resume

TECHNICAL PLATFORMS:

SalesForce: Intermediate knowledge specific to data entry for DME patient sales and case management, including their “Doc Scrub” application.

DOS Based Systems: EBPA used DOS based systems for their medical and dental claims

Web - based Access System: Medicare’s Provider Services Portal, MassHealth’s DDE claim submission system (replace / void claims), ClaimShuttle electronic submission for Medicare, SalesForce, ADP, One Source Passport, and ReMy.

Homecare Net and Homecare 360: Advanced working knowledge of this system for billing and collecting on durable medical equipment in monthly rentals, sales, and supplies, as well as home infusion services. Ability to alter patient files for specific billing requirements; eligibility, contractual pricing, claim modifier requirements.

CPR+: Beginner knowledge in infusion claim collections and corrected billing for appeals.

Ascend: Beginner knowledge with experience in durable medical equipment and infusion claim collections for corrected billing for appeals.

Microsoft Office: Word, Excel, PowerPoint - Intermediate knowledge

Adobe: PDF Reader and Writer - Intermediate knowledge

HIP A A: Compliance training completed annually

EMPLOYMENT:

Confidential

Case Management Specialist

Responsibilities:

  • Responsible for training new hires interdepartmentally across Sales, Reimbursement, and Case Management as part of the company training team. This includes participation in “Train the Trainer” meetings and exercises.
  • Responsible for data entry for new patients and affiliated doctors and practices, including attaching document files to correct patient accounts within SalesForce.
  • Maintain accurate records with up to date information to ensure prompt turnaround time for benefit investigations and medical authorization submissions for both new and reorder status patients.
  • Working knowledge of current national private and government medical and pharmaceutical insurance plans while coordinating with third - party vendors to ensure the best coverage and benefit costs for patients.
  • Working knowledge of national medical insurance requirements for insulin pumps and supplies to coordinate with peers both in the office and out in the field for accurate document requests to affiliated medical providers.

Confidential

Reimbursement Coordinator

Responsibilities:

  • Responsible for billing and collecting client medical insurance claims for Accounts Receivable.
  • Collect Medicare fees for service specialties and gained a more advanced knowledge on understanding payment rules for successful collection opportunities.
  • Gained independent knowledge through research on correcting issues and passing along discovered information to team members.

Confidential

Benefits Specialist

Responsibilities:

  • Assigned supervisor-assisting tasks, such as auditing peer work during QA for medical and dental benefits, handling of escalated beneficiary calls, and side-by-side training of new hires.
  • Handled incoming calls from medical providers regarding health insurance / benefit information.
  • First-level QA of tuition claims, assessing for accuracy before giving claims to the processors.
  • Assigned accessibility and responsibility to determine qualifying documentation for claims payment for FSA cards, due to knowledge and understanding of IRS guidelines.

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