CAREER SYNOPSIS
I am a highly motivated professional. I have in excess of ten years of experience in the healthcare marketplace. I am extensively experienced in the area of Medicare administration, claim compliance, and claims processing. My wide-range of knowledge in the field of workers compensation claims, billing and claims processing has provided me with a successful track record in customer service, healthcare, leadership skills, product knowledge and effective time management skills. It is my objective to secure a career opportunity with a cutting edge health care service organization. This organization will allow me to utilize my experience in the areas of healthcare management, workers compensation claims review, Medicare compliance, claims coding, claims processing, and A/R collections.
ACCOMPLISHMENTS
• Key member of implementation team during pilot initiative for the installation of proprietary network software used for tracking of benefits and claims issues. Testing was completed two weeks prior to the deadline and $50,000.00 under budget as determined by the national organization. Results were used as a template by the national organization during the national project implementation.
• Facilitator and team member for cross-functional work team that received national recognition and monetary rewards. Process improvement was done in the area of claims adjudication for claims service center. Project resulted in 30% reduction in claims turnaround time. This resulted in cost savings of more than $185,000.00 over a six-month period of evaluation.
JOB HISTORY
2010-Present Gentiva Health Services, Sandy Springs, GA, Care Team Coordinator: Schedule home healthcare visits for Registered Nurses, Physical Therapist, Occupational Therapist and Medical Social Workers. Review submitted paper work for completeness, accuracy, and appropriateness. Notify clinical manager of any inconsistencies. Verify patient schedules for accuracy and note changes (note frequency and duration compliance). Enter data for interim orders, discharge data, OASIS and plan of treatment, and authorizations. Review the following reports with manager, such as order variance report, Medicare eligibility verification report, Medicare eligibility re-verification report, and recertification list. Process payroll for clinicians. Activate patients, new employees, print daily schedule for clinicians. Handle all patient phone calls in a timely and prompt manner.
2005-2010 Peachtree Orthopaedic Clinic, Atlanta, GA, Account Representative: Account Representative for two well respected Orthopaedic doctors. Prepared weekly and monthly A/R reports for office procedures, as well as surgical billing. Responsible for posting surgical and workers compensation claims for billing. Communicated with workers compensation adjuster...
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