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Candidate's Name
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SUMMARY OF QUALIFICATIONS

 19 years of experience in healthcare administration and customer service
 Extremely well-versed in ICD 9/10, CPT codes
 Highly educated in claims processing, insurance verification, prior authorizations, billing discrepancies, EOBs/EOPs, physician credentialing, fee negotiations and HIPAA
 Proficient with Microsoft office, QNXT, Med-ware billing system, WC and no fault

PROFESSIONAL EXPERIENCE

Utopia Claims Concepts 2/2015/-12/2015
IME Coordinator
Scheduled independent medical evaluations for worker s compensation and no fault claims
Maintained physician s appointment log
Coordinated transportation and interpretation services for claimants
Recruited and credentialed new physicians to the panel
Billed insurance carriers for services rendered.

1199 SEIU Benefit and Pension Fund - New York, NY
Billing/Fee Negotiation Coordinator 4/2008-6/2010, 1/2012-5/2014
 Negotiated fees for services rendered by non-contracted providers
 Redirected HCFA/CMS 1500 and UBO4 claims to appropriate departments for processing
 Assisted providers with correction of billing/coding errors, claim appeals and claim submissions/resubmissions

Quality Control Reviewer PR Call Center 4/2005-4/2008
 Provided training and assistance to customer service representatives
 Provided information regarding, claim status, member eligibility/benefits, and prior authorizations
 Resolved escalated claim disputes and provider inquiries

Hospital/ Medical Claims Processor 7/2002-4/2005
 Reviewed hospital/professional claims for correct coding and billing
 Processed UB92 and HCFA 1500 claims according to patient eligibility, procedure approval and fund s policy

Local 1115 Benefit and Welfare Fund - Westbury, NY
Pre-Certification Specialist 3/1999-7/2002
 Coded and issued referrals and prior authorization for diagnostic and surgical procedures
based on physician requests
 Coordinated and authorized discharge planning for patients released from hospital care
 Coordinated and authorized outpatient mental health services.

EDUCATION

 2011-University of Phoenix, Phoenix, AZ   Associate s Degree, Psychology
 2016-NLBI Institute, Jamaica, NY   Medical Billing/Coding Certificate