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Click here or scroll down to respond to this candidateCandidate's Name , MBA, BBA 27060 Grandmont, Apt. 13 Roseville, MichiganStreet Address Phone: PHONE NUMBER AVAILABLE E-mail: EMAIL AVAILABLE Seeking full-time position inHEALTHCARE ADMINISTRATIONClaims Analyst / Billing Instructor / Claims Examiner / Health Insurance Software Trainer / Team Leader /Medicaid / Medicare/Membership and BillingHighly experienced in managed-care and health service administrative positions. Expertise in Software Training, claims processing, Precertification and optimizing a companys organizational infrastructure, health products, processes, measurement systems and electronic medical record systems. AREAS OF EXPERTISEMedical Billing InstructorProvider Claims and BenefitsTeam BuildingHIPPA, Enrollment, Secondary PayerMedicaid and Medicaid ProductsTeam Building, Motivation, and PerformancePerformance, Pre-certificationClaims ProcessingKEY CAREER ACCOMPLISHMENTSTRAINING SPECIALIST & INSTRUCTIONAL DEVELOPERFacilitated training seminars for providers and health care professionals.Developed and implemented a Quality Improvement Process, integrated customers into the process, and established procedures for all phases of production, quality training and administration.Trained, motivated, mentored and supervised a staff of 15 employees in the effective delivery of customer service and administrative tasks.Updated training manuals, PowerPoint Visuals, and Facilitated Webinars for internal and external stake holders.EMPLOYEE TRAININGDeveloped and implemented customer service training classes designed to enhance both technical and soft skills.Delivered superior customer service while working with clients on a daily basis for various new and on-going training projects.CAREER HISTORYCustomer Service Claims Representative Trinity Health Systems October 2018 - August 2020 Farmington, MIDiscussed detailed claims information, effective dates of coverage, employer group benefits and policy information. Processed claims inquires, primary care physician changes per subscriber requests. Answered incoming telephone and written inquires from members and providers. Reviewed inpatient and outpatient inquires for claims review. Provided claims and authorization information to providers located in the state of Michigan and Idaho. Responsible for monitoring aged and pending claims Medical Billing Instructor Abcott Institute Southfield, MI January 2016 June 2019Responsible for instruction of students by using the latest edition of textbooks and test methods. Instructor is also responsible for the submission of grades for each course completed by the student based on in house test and planned curriculum. Instructor also teaches and prepares students for national exams. Maintains a congenial and healthy learning facility as well as help keep lab and classroom clean and free of debris. Instructor may also request specific dates for externship site (by Director of Career Services or School Director) for students. Instructor may also accompany students to externship sites. Medical Billing Instructor Dorsey Schools Madison Heights, MI August 2017 December 2019Plan, prepare, and deliver quality classroom instruction in lecture, clinical, and/or laboratory format based on the approved course outline by selecting and utilizing a variety of approved course materials and teaching methods that address all learning modalities to insure that the needs of individual students in the program are met. Critical Claims Analyst NGS Coresource Clinton Township, MI June 2015- June 2016Coordinated all pre-determinations/pre-authorization requests and reviewed all claims triggered for critical claims referral and manual submissions including chemotherapy, cosmetic procedures, pain management, unlisted codes, implants, etc. Reviewed various drug charges and provides recommendation for discounts negotiations on going treatments.Customer Service Rep 2September 2014 February 2015 Molina Healthcare of Michigan Troy, MI Responded to incoming calls from members and providers including claims calls, discussing detailed claims information, effective dates of coverage, secondary payer information, primary care physician changes, benefit and coverage information.Precertification Representative Blue Cross/Blue Shield of Michigan February 2014 - September 2014Processed incoming precertification request for facilities in the U.S. Answered incoming calls and inquires pertaining to precertification and responsible for resolving issues and concerns of stakeholders. Payment Training Specialist Henry Ford Health System March 2011- December 2012Conducted on- site training sessions for Customer Service Representatives. Updated training manuals, cheat sheets and job aids. Refreshed Desktops computers for installations, worked with Oracle and WebEx. Instructional Developer/Trainer Blue Cross/Blue Shield of Michigan June 2005- February 2009Provided facility training sessions and webinars for Web DENIS and facility billing. Ensured compliance with State Regulations for incoming and outgoing correspondence along with claims reviews. Decreased claims error and resubmissions by 20 percent. Worked on special projects and other duties as needed. Team Leader Blue Cross/Blue Shield of MichiganApril 2004- June 2005Supervised all administrative, operative and employee functions within assigned area. Managed personal and vacation time requests, production standards, biweekly staff meetings, and generated various reports for leadership. Monitored aged and pending claims from various areas in Michigan Service Operations Division. Decreased the number of aged claims over 30, 60, and 90 days by 25%.EDUCATIONHealth Services Administration-MBA 2003Davenport University, Dearborn MIHealth Services Administration-BA 2001Davenport University, Dearborn MI |
