Experience

Berkley Medical Management Solutions (a Berkley Company)

• United States
• Insurance
• 1 - 100 Employee

• Clinical Care Service Specialist

  • Aug 2018 - Present

  • Collaborate with Nurses and other professional staff members to support clinical operations. • Manage referrals for Operating Units and/or Case Managers • Set tasks for TCM and self in each assigned case and monitor those tasks daily. • Update demographic or attorney information, work status and/or network provider information. • Initiate, retrieve, coordinate and forward medical records to vendors, providers, case managers staff as requested. • Request verbally and/or in… Show more • Collaborate with Nurses and other professional staff members to support clinical operations. • Manage referrals for Operating Units and/or Case Managers • Set tasks for TCM and self in each assigned case and monitor those tasks daily. • Update demographic or attorney information, work status and/or network provider information. • Initiate, retrieve, coordinate and forward medical records to vendors, providers, case managers staff as requested. • Request verbally and/or in writing medical notes, work status and next appointment details. • Confirm medical appointments, therapy visits, translation/transportation visits. • Create and send out letters to the injured employee and appropriate parties. • Document essential functions completed within the assigned file per established policies. • Practice strict confidentiality in the handling of all data and communication. • Coordinate and successfully complete specific projects and initiatives as directed. • Coordinate referrals to vendors for transportation, translation, therapy, durable medical equipment, Independent Medical Exams • Managed incoming referral requests for Telephonic Case Managers, Field Case Managers and Utilization Review. • Assign Nurse Case Managers to files based on state licensures. • Analyze first reports of injury and identify key components to refer for additional case management. • Develop training material for the Clinical Care Service Specialist’s position. • Assist with new Employee orientation.

• Senior Medical Bill Revew Auditor

  • May 2013 - Aug 2018

  • Auditing medical bills for quality assurance and correct coding practices. • Reviewing jurisdictional rules and requirements set forth by Workers Compensation law and state laws. • Assigning rates per state fee schedules. • Reviewing appeals and disputes submitted by providers. • Answering emails and providing instructions on processes and improvements. • Assisting with policy and procedure documents for Business Units/Adjusters. • Train and lead the Call Center… Show more • Auditing medical bills for quality assurance and correct coding practices. • Reviewing jurisdictional rules and requirements set forth by Workers Compensation law and state laws. • Assigning rates per state fee schedules. • Reviewing appeals and disputes submitted by providers. • Answering emails and providing instructions on processes and improvements. • Assisting with policy and procedure documents for Business Units/Adjusters. • Train and lead the Call Center associates on provider calls, questions and bill issues/disputes. • Providing updates to Business Units on urgent issues and status request. • Main contact for American Mining Insurance company-updates to policies, procedures and assisting with negotiations. • Assist managers on status of claims, bills and urgent matters.

• Medical Billing Clerk

  • Feb 2012 - May 2013

  Performed accurate data entry of information from medical bills, legal statements, pharmacy invoices and other miscellaneous bills into the Power1 claim system. • Maintained a daily quota of 200 bills. • Determined funding for bills by identifying CPT codes, diagnosis codes and provider types. • Managed priority clients with urgent turnaround times. • Issued letters to providers for request of proper medical billing forms.



Truliant Federal Credit Union

• United States
• Banking
• 500 - 600 Employee

• Member Service Representative

  • Oct 2009 - Nov 2010

  Processed deposits, withdrawals, loan payments, issued certified checks and cashed checks. • Maintained a cash drawer of $20,000. • Managed the branch vault and cash limits daily. • Balanced Automated Teller machine for the branch. • Ordered, packaged and shipped money to maintain credit union limits. • Provided exceptional customer service to meet the needs of customer’s financial needs. Processed deposits, withdrawals, loan payments, issued certified checks and cashed checks. • Maintained a cash drawer of $20,000. • Managed the branch vault and cash limits daily. • Balanced Automated Teller machine for the branch. • Ordered, packaged and shipped money to maintain credit union limits. • Provided exceptional customer service to meet the needs of customer’s financial needs.