Career Summary
Seasoned health care professional with over 10 years’ experience in the managed care industry. Experienced in Medicaid, Medicare and commercial area; ability to develop strategic and visionary solutions to business problems; committed to continuous quality improvement and operational excellence within the healthcare delivery system.
Certified coding professional with sound knowledge of anatomy, physiology and medical terminology; capacity to work independently as well as part of a team; ability to exercise discretionary judgment and problem solve; excellent communication, interpersonal and organizational skills; ability to meaningfully engage other coding professionals, provide feedback, teach and lead by example.
Employment History
Biller 2/2010- 6/2010
Eagles Landing OBGYN, Stockbridge, GA
• Collection calls made for accounts past 30 days
• Collections of money for outstanding balances
• Research denied claims for error and resubmission
• Calls and letters to insurance companies for corrections of claims and appeals
• Pulled and return medical charts
• Correction and resubmission of claims
Manager, Provider Relations 7/2005- 10/2008
Amerigroup, Atlanta, GA
• Implemented a training program to ensure provider relation representatives were thoroughly knowledgeable about the company’s services and products. (these services included credentialing, provider education and recruitment)
• Enhanced servicing standards by educating client staff on the benefits of using ERA (Electronic Remittance Advices and EFT. (Electronic Fund Transfer)
• Identified changes needed to client servicing standards which resulted in a 30% increase in quality client visits.
• Contributed to earnings improvement opportunities and strategic direction of the network by identifying needed changes.
• Ensured accurate configurations of contract, reimbursement rates and benefits were up-to-date by building relationships with relevant departments.
• Ensured clients claims and coding questions were answered accurately and timely by developing a report which tracked completion rates.
• Realized timely and accurate feedback to clients for each rural hospital in the rural, northern region of Georgia by managing the scheduling for Joint Operations Committee (JOC) meetings and outlining all issues in a problem matrix for all departments.
Provider Relations Representative 5/1996- 9/2005
Amerigroup Corp. Edison, NJ
• Achieved more accurate data by maintaining up-to-date knowledge, best practices, applications, and policies and procedures on clients.
• Participated in network contracting for existing and new ancillary contracting and provider relations issues that resulted in an appropriate network of physicians and allied professionals to se...
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