| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLESummary of QualificationsD i s p u t e A n a l y s i s C u s t o m e r S e r v i c e R e c r u i t m e n t O p e r a t i o n sResourceful Provider Dispute Analyst with a keen ability to meticulously analyze, research, and efficiently resolve payment claims within designated timelines. Committed to providing exceptional service and ensuring customer satisfaction. Seeking to leverage skills and experience to contribute to the success of a reputable organization.C o r e C o m p e t e n c i e s :Claims Processing Resource Management Services & Procedures End-To-End Recruitment Operations Candidate Sourcing & Selection Training & Development Team Building & ManagementEducation ExperienceWayland Baptist University, San Antonio, TXMasters Degree in Business Administration and Human Resources02/2018-6/2019Wayland Baptist University, San Antonio, TXBachelors Degree in Business Administration and Medical Management08/2016-08/2017Kaplan College, San Antonio, TXAssociate Degree in Business Administration and Medical Practice Management10/2009-02/2011Judson High School, Converse, TXDiploma, 1991Computer SkillsAdvanced computer skills in Access, PowerPoint, WordLearns new software applications quicklyKeyboard/Type 50wpmEmployment Experience3M/KCI 08/2021-PresentCSR/Insurance VerificationAssists Clients and Customers, via telephone, e-mail or chat, with orders, inquiries, requests, problem resolution, and comments/feedback regarding products/services and verification. Consults with Clients and Customers to identify additional needs related to the products or services. Insure Correct billing ICD10 are applied. Recommends appropriate products, services, or solutions. Works on assigned client programs. Performs duties in a courteous, efficient, and professional manner. Work directly with Government and Commercial Insurance verification of coverage and benefits to include processing of all medical devices and supply orders.Bright HealthcareProvider Dispute Analyst 07/2021-8/2023Efficiently reviewed and researched dispute cases, resulting in accurate claims reprocessing, and adeptly created and maintained appeal response templates.Functioned as a valuable departmental resource for appeal-related concerns and consistently maintained a robust grasp of fundamental medical terminology to enhance comprehension of services and procedures.Leveraged effective problem-solving skills to drive dispute resolutions, fostering mutual understanding of opposing viewpoints.Thoroughly validated and ensured the accuracy of documentation on updated systems.Consistently adhered to departmental processes, procedures, and goal expectations for conducting case investigations.Investigated, researched, and promptly resolved payment claims within stipulated timeframes.Maintained current industry knowledge, and tracked system updates, network regulations, and compliance matters.Demonstrated sound judgment and utilized available resources to make informed decisions for case approval or denial.Patient Solutions 01/2021-7/2021Office Manager/Medical BillingAssists Clients and Customers, via telephone, email or chat, with orders for DME, inquiries, requests, problem resolution, and comments/feedback regarding DME equipment (CPAP/APAP devices, wheelchairs, and supplies). Medical Billing Department AR reporting, posting and balance patient account, billing medical insurance and private pay. Conduct daily office task of order supplies, inventory, and maintain office employment.Medtronic San Antonio Tx. 07/2XXX-XX-XXXXSupply Manager/Insurance VerificationAssists Supply Clients and Customers, via telephone, e-mail or chat, with orders, inquiries, requests, problem resolution, and comments/feedback regarding products/services and verification. Consults with Clients and Customers to identify additional needs related to the products or services. Recommends appropriate products, services, or solutions. Works on assigned client programs. Performs duties in a courteous, efficient, and professional manner. Work directly with Government and Commercial Insurance verification of coverage and benefits to include processing of all medical devices and supply orders.United Healthcare, San Antonio, Tx 03/2013-6/2014Enrollment Processor, Provider Data Analyst, Grievance &Appeals CoordinatorHandled special projects from outbound calls to internal paperwork needing to be entered into the system.Received tasks from other departments to handle, was given Helpdesk role for CIP after 4 months of employment.Managed about 10-15 people and provided training and individual coaching sessions for all associates.Maintained detailed and accurate records between multiple databases and programs.Checked documentation for accuracy and validity on updated systems.Maintained confidentiality of patient eligibility, records, and heath statuses.Verified client information by analyzing existing evidence on fileHandled escalated issues for member by making outbound calls to provider and other entities.Assisted members with claims questions regarding diagnosis codes, copayment, appeals, fraud claims and reimbursement requests.Created and maintained multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections.Scheduled monthly provider verifications regarding provider enrollment specifications and demographic changes.Updated delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance.Reviewed appeals, complaints and claims from providers, determined validity and help build satisfactory resolutions.Managed time efficiently in order to complete all tasks with deadlinesUnderstood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.Conducted full claim and appeal investigations and reported updates and resolutions.Maintained knowledge of benefits claim processing, claims principles, medical terminology, appeal procedures, and HIPAA regulations.South Texas for Pediatric Care 10/2010-02/2013Billing SpecialistObtain new sales information from managers and prepare invoices to be sent to patient/customers. Interact with patients via phone and email regarding unpaid balances and discuss options for payment. Set up payment plans for customers upon request and provide updated information to accounting manager. Cross-check information entered into bookkeeping software to ensure accuracy and report any discrepancies to manager. Trained incoming staff members on office billing practices and procedures.Additional References are Available Upon Request |
