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Click here or scroll down to respond to this candidateCandidate's Name
Street Address (Cell PHONE NUMBER AVAILABLE EMAIL AVAILABLEAward-winning professional with many years of proven progressive experience ranking as a top performer in customer-support management, focusing on the insurance industry. Recipient of numerous awards for outstanding customer service, exceptional management, attendance, and going above and beyond. Friendly team player with excellent communication and interpersonal skills needed to deliver superior customer service.Core competenciesCustomer Service/Support, Account Management, Client Relationship Management, Quality Assurance Control, Issue Resolution, Process Review and Development, Date Management, Financial Management, Personnel Management, Hiring, Employee Training Team Building, Performance Review, Microsoft Word, PowerPoint, and Excel.Professional ExperienceChildrens Hospital of Philadelphia 03/21 - 01/22Patient Financial Services Interim SupervisorComplete weekly management reports and send to appropriate personneloAR Trend ReportoCash Metric ReportoAR Metric ReportComplete and send the Transition Monthly Report to the PAC Manager the last week of the monthComplete and send the International Patient Report on the first of each month and send to Christine DeckhutComplete and file the Home Care Statement Report by the fifth every month and file in the statement fold for our vendor to pick up and generate statementEnsure the AR staff completed all rejected, hold, and incomplete claims on a weekly basisEnsure the AR staff completes the department goal of working 10 credits weeklyFollow up with AR staff members if 60 invoices are not completed dailyRespond, assist, and resolve to any payor concerns from the AR staff.Respond and resolve to any Billing concernsRespond and resolve any Cash Posting issuesRespond and resolve any patient billing or eligibility issuesRespond and resolve any Change Health Vendor issuesAttend all payor conference callsRespond to any requests from insurance representativesRespond to any Pharmacy Management RequestsRespond to any Patient Account Coordinator requestsApprove any PPL requests that are sent to you making sure proper department coverage is met.Resolve any department personnel conflictsPatient Financial Services Accounts Receivable\ Payable Representative 01/16 PresentThe primary focus of the account receivable is to provide consistent follow up on the open account receivables. Responsible to review payments received for services rendered and to determine contractual compliance. Responsible to provide payment disputes in a timely manner per payor, contractual and regulatory guidelines. Work with the interdisciplinary team and appropriate pre-certification coordinator to assure authorization issues are resolvedPerform payment disputes timely and in accordance with payor, contractual, and regulatory guidelines. Document all follow up activities into the patients medical record.Review payments for accuracy. Identify and report all issues related to contractual compliance to managementComplete payor projects as assignedAssist in obtaining/ maintaining departments cash goal collectionProvide all Home Care reimbursement functions in accordance with CHOPReinforce all CHHC policies and regulatory accrediting agency guidelinesPreform necessary account collections when needed.Document all patient account activityIssue invoice refunds when necessaryProcess credit card payments and refundsConfirm patient insurance eligibilityCompleted all assigned projects and auditsProficient in EpicProficient in FastrackPre-Certification,Claim Billing / CodingPrimePayBenefit Supervisor / Trainer 01/15 01/16Supervise 14 associates responsible for contracts, account reconciliation, billing, and eligibility. Ensure that all COBRA and Health Care Reform regulations are followed for federal compliance. Additional responsibilities include training, coaching, counseling, providing feedback on performance, and timesheet approval.Monitor staffing resources and determine staffing requirements on current and anticipated projects.Establish and cultivate relationships with clients by assisting with resolution of issues and managing client expectations.COBRA/ FSA/ HRA Remittance Reconciliation on all accounts, Invoicing, Claims, FSA, HRAFinancial Reporting on Cash Reconciliation/ Collection/ New AccountsConducted formal training classes for all new hires on all benefit product products (Cobra, FSA, HMO, PPO, HRA)Performed client presentations for all benefit productsLiaison for all special accountsTrionCobra Supervisor 05/12 01/15Supervise 16 associates responsible for contract, account reconciliation, billing, and eligibility. Ensure that all Cobra and Health Care Reform regulation are followed for federal compliance. Addition responsibilities include training, coaching, and counseling, providing feedback on performance, and development, and timesheet approval.Monitor staffing resources and determine staffing requirements based on current and anticipated client projects.Establish and cultivate relationships with clients by assisting with resolution of client issues and managing client expectations. Continuously monitor business processes and systems and make recommendations for improving best practices.Cobra Reconciliation on all Cobra Accounts on a monthly basis (644) to ensure proper remittance to the employerPSCAccount Manager 3/08- 05/12Manage/develop business in assigned territory, maintaining/expanding existing healthcare client accounts and prospecting for new accounts. Set up new accounts, prepare invoices, troubleshoot accounts, and prepare status reports.Build and maintain strong, long-term client relationships through networking, meetings and phone contact.Provide award-wining service by promptly following up with clients and resolving customer issues and concerns.Train/mentor new associates, coordinate data mapping, analyze sales trends, and develop sales strategiesAetna Incorporated Blue Bell, PAMedicare Consultant 6/07 3/08Provided critical support for Medicare service operations, including service analysis planning, testing design, development, implementation, and maintenance. Created vendor/customer specifications. Coordinated projects.Performed market research and analysis, and developed informative presentations with recommendationsInterviewed internal and external customer to define and develop forward-looking information products.Supervised all yearly Open Enrollment activityHMO/PPO/AR Billing/Cobra/Enrollment Supervisor 9/04 6/07Led a team on 30-35 associates responsible for plan administration and functional support. Evaluated customer accounts to ensure satisfactory product delivery. Coordinated research for managing delinquent client accounts. Performed audits on Cobra Accounts to ensure accuracy.Monitored customer satisfaction against quality assurance, audits, and performance management initiativesTrained associates, processed payroll, conducted performance reviews, and managed attendance/benefits.Application Support Manager 10/01-09/04Provided day-to-day support and expertise, including conduction interviews, performing independent research, and preparing fact-finding reports to develop innovative IT solutions for a wide range of operational problems.Assisted project manager in transitioning Prudential Healthcare business into the Aetna Healthcare platform.Acted as internal consultant/project lead to support IT and business area system-functionality inquiries.Financial Account Receivable Unit/Cash Application Manager 7/00-10/01Hired, trained, led, and directed a team of 15 employees responsible for accurate and timely cash control, payment processing within 24 hours, date-entry processing, and cash-batch operations. Promptly resolved Client-relation issues.Evaluated inventory levels and workloads, and reviewed all refund recommendation prior to authorizationsCall Center/CCU AR Manager 04/98 -7/00Hired, trained, and directed 35 employees responsible for mail processing, payment processing, and enrollment application activities Developed microfilm process and held full responsibility for resolving client-relation issues.Supervised phone staff and maintained unit ASA of 30 Seconds or less and an abandon rate of less than 1%Met all department phone-coverage metrics and ensured application of all checks to accounts within 24 hours.Education Associate Degree in Business |
