ENTERPRISING, HARD-WORKING AND TECHNICALLY SKILLED HEALTH INSURANCE SPECIALIST known for accuracy, attention to detail and timeliness in managing receivable functions for diverse-industry employers. Insurance career spans ••••• years of experience in Commercial, Managed Care, Medicare, Medicaid claims and benefits.
Heartland of Oregon/Long-Term Care Facility-BOC- Department Head Oregon, Ohio
Business Office Coordinator
Handle daily A/P processes and A/R processes; supervise A/P clerk; managed vendor/attend staff meetings, departmental head meetings.
Attends weekly UR meetings. Verify and update census report by status for previous business days.
Review of actions summary report. Reconciles census with Clinical and Admission.
Performs payer verifications and enters all CASH payments, resident trust fund, PPA payments.
Reconcile facility bank statement monthly. Reconcile Resident Trust Fund.
Contact new admissions to discuss financial information. Ensure that deposits are done daily.
Maintains Medicaid Pending log. Audit of Business Files weekly.
Close cash period monthly. Weekly collection calls to resolve open balances.
Bill and code workman compensation claims.
Reconcile daily journal entries for all cash and check deposits.
Enter all ancillary services daily to bill for accounts payables.
Audit of all accounts payables.
Meet with families regarding their accounts payables and insurance questions.
Travel for meetings at Jobs and Family services to start application process.
ProMedica Financial Services-CBO Toledo, OH
Government Billing Analyst••••• •••••/••••• to •••••/•••••
Responsible for submitting claims and following up with insurance companies.
Prepares and submits clean claims to Medicare, SNF and Home Health Care facilities.
Responsible for calculation of SNF rates and reimbursement.
Daily follow up for RTPed claims and patient eligibility on Medicare Online system, (HIQA, FISS).
Daily report review, credit balance reports, insurance verification, aged trial balance.
Review and analyst of monthly cash report to determine if cash goals are met.
Answer questions from patients and providers regarding claim submission and payment.
Assist in training and development with current and newly hired employees.
Identified and resolved patient billing complaints.
Submission of patient private statements.
Participate in educational activities and attended weekly/monthly staff meetings.
Maintained strictest confidentiality adheres to all HIPAA guidelines/regulations.
Great Lakes Risk Management Health Insurance Brokerage
Employee Benefits Customer Service Representative ••••••••••/••••• to •••••/•••••
Provided administrative support t internal and external clients, working directly with CEO.
Meetings with one-on-one and employee group communication regarding group and retirement benefits plans.
Daily reporting information to employees regarding, group and self-funded medical, disability, and retirement benefits.
Administrative duties include, assistance with filing of medical, vision, dental, STD/LTD claims. Prepared all documents with included, follow up letters.
Assisted with the preparation of employee education. Prepared newsletters and PowerPoint presentation for employer groups.
Assisted with resolutions with employee concerns regarding their medical, dental, and ••••• k plans.
Prepared summary of explanation of benefits for employer groups and employees.
Preparation of reports, analyzing data and identifying solutions for employer groups.
ProMedica Physicians Group (PPG)- Toledo, OH
Commercial & Workman Compensation Accounts Receivable •••••/••••• to •••••/•••••
Proceeded follow up with claims pending monthly reports.
Follow up with providers to facilitate resolution of outstanding accounts for over ••••• ProMedica physicians.
Performs various collections actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
Monthly ATB report for follow up from commercial group insurance payers and Workman Comp payers.
Posting cash payments received from insurance carriers.
Medical Mutual of Ohio Toledo, OH
Customer Service/Provider Inquiry Department ••••• •••••/••••• to •••••/•••••
Provided support to various providers, doctors and hospital billing departments.
Customer service support, insurance verification, claims status.
Adjusted medical claims online for payment.
Family Health Plan-Toledo OH.
Claims processor, Claims Analyst, Claims Auditor••••• •••••/••••• to •••••/•••••
Provided training to new hires and temporary employees.
Prepared training materials, PowerPoint presentations and various training documents.
Audited claims processed to ensure providers received correct reimbursement.
Adjusted/Adjudicated denied claims for payment.
Processed medical, dental, vision, HCFA and UB••••• claims.
Claims pricing for outlier amounts to manually price DRG for inpatient claims.
Prepared monthly audit reports for Claims Manager.
Monthly review of audit reports for quality improvement for claims processing.
Macomber/Whitney High School
Edward Drummond Libby High School - •••••
University of Toledo- AAB Business Administration
Deans List •••••
University of Toledo-AAB Marketing & Sales Technology •••••