OBJECTIVE

• To pursue a position that will allow great growth potential highly related to my professional healthcare reimbursement working experience.
• I wish to continue to excel and advance based on my great achievements of exceeding all goals.
• I have 7 years of experience which includes me working as a Utilization Management Specialist, Claims CSR II, Financial Specialist I, and as an Assistant Manager. Some of my skills and experiences include: Meeting Facilitation, Policy Analysis, and Investigation.
• At dis point in my career, I am searching for a position that would be a perfect fit, so I am open to relocating for the right opportunity.

TECHNICAL SKILLS

• Medical databases knowledge
• Microsoft Office, Excel, Outlook, PowerPoint, Access
• FMLA, STD, LTD
• CERNA, CPSI, Star, Citrix, MPF, Mckesson
• EHS /Greenway Practice Software
• Medical Coding
• Data Entry
• Collections
• Healthcare Management
• Presentation skills
• Set up, sort, create graphs/charts/trend reports
• ICD - 10
• EHR
• PEGGA
• WBS Callcare 2.0
• WMDS
• EMR
• Health Information Management
• Customer Service Management
• U.S. Health Insurance Portability and Accountability Act (HIPAA) 2017
• Healthcare Analytics
• Tricare
• Abstracting
• Professional Communication
• Professional Writing
• HIM Operations
• E/M coding
• Specialize in Hospital Revenue Cycle
• Current Procedural Terminology (CPT) & HCPCS knowledge
• Insurance Product Marketing
• Organization & Prioritization skills
• Time Management skills
• Medicaid and Medicare regulations knowledge
• Medical Terminology Knowledge
• Anatomy & Physiology knowledge
• Medical law knowledge
• Accurate & proficient data entry/10-key abilities and 45WPM
• PEGA
• Optma
• WGS
• CITRIX
• NASCO
• EncoderPro
• Adobe Connect

PROFESSIONAL EXPERIENCE

Utilization Management Specialist

Confidential - Columbus, GA

Responsibilities:

• Responsible for coordinating cases for precertification and prior authorization review
• Manage incoming calls and incoming post services claims work
• Determine contract and benefit eligibility
• Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
• Refer cases requiring clinical review to a Nurse reviewer
• Responsible for the identification and data entry of referral requests into the UM system in accordance wif the plan certificate
• Respond to telephone and written inquiries from clients, providers, and in-house departments
• Conduct clinical screening process
• Authorize initial set of sessions to provider
• Check benefits for facility based treatment
• Develop and maintain positive customer relations
• Coordinate wif various functions wifin the company to ensure customer requests and questions are handled appropriately in a timely manner

Medical Claims Specialist CSR II

Confidential - Columbus, GA

Responsibilities:

• Provided prompt customer service to policy holders, providers, agents, and other internal company entities regarding claims
• Investigated claims to detect fraud
• Established and maintained liaison network wif public officials, law enforcement officers, and others to obtain assistance in conducting investigations
• Identified cases for potential insurance fraud prosecution and submits questionable claims to the National Insurance Crime Bureau. Testified to findings
• Documented phone calls in the system and followed up on issues if needed
• Assisted wif password resets and remote support
• Helped policy holders troubleshoot issues
• Outlook and Excel
• Contacted insured and other appropriate persons to verify the accuracy and completeness of information on claim forms and related documents
• Responded to inquiries from policy holders, providers, agents regarding claim status and policy provisions
• Provided investigative expertise to detect fraud, limit exposure and protect company assets
• Composed and generated letters to request information or confirm action taken
• Communicated accurate information about guidelines and regulations
• Gained knowledge of insurance policies, procedures, claims, medical terminology, ICD-9, ICD-10, EMR, HIPPA, and Medicaid/Medicare regulations, and Tricare
• Provided thorough and accurate responses to customer requests/inquiries received via Internet, phone, and documents
• Gained knowledge of Specified Health Event, ICU, Hospital Indemnity, Vision, Dental, Cancer, Accident, Life, Short Term Disability, and Medicare Supplemental

Financial Customer Service Representative

Confidential - Columbus, GA

Responsibilities:

• Reviewed expired accounts and communicated wif customers to promote timely payments (Collections)
• Maintained accurate records of past due account activity
• Compiled and sorted invoices and checks
• Issued checks for accounts payable
• Collection calls
• Completed duties wif Excel
• Recorded transactions and data into QuickBooks
• Corrected rejections and accounting errors for accurate amount processing
• Maintained ledgers and processed sales contracts
• Posted payments to customer accounts and made bank deposits
• Processed credit card payments over the phone
• Copied, filed, scanned, and uploaded documents
• Networked wif partnership store personnel (Rooms To Go Furniture Store) to gain referrals and educated partnership store staff on the rental process
• Created, managed, and executed plans to increase sales and conversion percentages, by creating create graphs, charts, and trend reports
• Educated referred customers on the rent-to-own transaction, including pricing options, features, and benefits
• Gauged store performance by monitoring weekly, monthly, quarterly performance, and financial reports

Patient Access Representative

Confidential - Columbus, GA

Responsibilities:

• Collected and entered patient demographic, personal, and financial information
• Entered physician orders for prescribed tests, supplies, and procedures
• Made sure the physician filled the office notes and signed them correctly
• Verified previous admissions prior to initiating the admission process to ensure non-duplication of medical records numbers
• Interviewed incoming patients
• Gatheird and documented demographic insurance and financial information accurately
• Coordination and scheduling
• Reviewed charts for accuracy and completed charts from prior shifts
• Informed patients at the time of admission and/or registration co-pays/deductibles and private room difference are due a time of admission/discharge
• Scanned charts, x-rays, inbound labs, and prescriptions into the EHS /Greenway Practice Software
• Updated EMR
• Verified Tricare, Medicaid, Medicare, and other Health Insurances

Assistant office manager

Confidential - Columbus, GA

Responsibilities:

• Gained knowledge of HIPAA Compliance policies and how to protect the privacy of the medical records
• Used coding and billing software
• Completed medical office insurance forms
• Classified and filed various coding and billing information
• Analyzed coding and reimbursement-related financial data
• Showed competency in medical reimbursement process
• Documented strategies
• Submitted Personal Injury Claims
• Scheduled appointments
• Verified Insurance (TRICARE, MEDICAID & MEDICARE, COMMERCIAL INSURANCE)
• Gained knowledge of ChiroTouch
• Collected Payments
• Gained knowledge of Insurance Claims
• Processed Personal Injury Billing