Experience

Bottom Line Systems

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Managed Care Analyst

  • Aug 2015 - Present

  Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client. Build strong, lasting relationships with clients, payors and BLS personnel Review insurance contracts to gain thorough understanding of payment methodologies Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting… Show more Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client. Build strong, lasting relationships with clients, payors and BLS personnel Review insurance contracts to gain thorough understanding of payment methodologies Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other BLS personnel Support and direct claims to all BLS departments and client onsite analysts Attend client, department and company meetings Comply with federal and state laws, company and department policies and procedures Show less Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client. Build strong, lasting relationships with clients, payors and BLS personnel Review insurance contracts to gain thorough understanding of payment methodologies Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting… Show more Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client. Build strong, lasting relationships with clients, payors and BLS personnel Review insurance contracts to gain thorough understanding of payment methodologies Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other BLS personnel Support and direct claims to all BLS departments and client onsite analysts Attend client, department and company meetings Comply with federal and state laws, company and department policies and procedures Show less



Carolinas HealthCare System

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Home Infusion Coordinator

  • Nov 2010 - Jul 2015

  Documented patient information obtained from interviews. Evaluated patient care needs, prioritized treatment, and maintained patient flow. Trained new staff on quality control procedures. Managed various general office duties such as answering multiple telephone lines, completing order forms for insurance purposes and creating order changes when needed. Implemented necessary changes based on evaluation of staffing requirements and floor assignments. Demonstrated ability to… Show more Documented patient information obtained from interviews. Evaluated patient care needs, prioritized treatment, and maintained patient flow. Trained new staff on quality control procedures. Managed various general office duties such as answering multiple telephone lines, completing order forms for insurance purposes and creating order changes when needed. Implemented necessary changes based on evaluation of staffing requirements and floor assignments. Demonstrated ability to lead and motivate outstanding healthcare teams. Contributed substantially to successful department JCAHO accreditation. Provided patient education. Managed team of medical support personnel. Show less Documented patient information obtained from interviews. Evaluated patient care needs, prioritized treatment, and maintained patient flow. Trained new staff on quality control procedures. Managed various general office duties such as answering multiple telephone lines, completing order forms for insurance purposes and creating order changes when needed. Implemented necessary changes based on evaluation of staffing requirements and floor assignments. Demonstrated ability to… Show more Documented patient information obtained from interviews. Evaluated patient care needs, prioritized treatment, and maintained patient flow. Trained new staff on quality control procedures. Managed various general office duties such as answering multiple telephone lines, completing order forms for insurance purposes and creating order changes when needed. Implemented necessary changes based on evaluation of staffing requirements and floor assignments. Demonstrated ability to lead and motivate outstanding healthcare teams. Contributed substantially to successful department JCAHO accreditation. Provided patient education. Managed team of medical support personnel. Show less



CVS

• CPhT - Certified Pharmacy Technician

  • Jul 2010 - Nov 2010

  Properly filled and dispensed an average of 100 prescriptions per day. Effectively resolved insurance rejections and other billing issues. Managed drug and supply inventories. Assisted other pharmacy staff with drug inventory, purchasing, and receiving. Regularly stocked shelves, rotated stock and checked for expired medications. Performed technical processes required to dispense medications to patients. Assisted the pharmacists with checking in and pricing drug orders, third… Show more Properly filled and dispensed an average of 100 prescriptions per day. Effectively resolved insurance rejections and other billing issues. Managed drug and supply inventories. Assisted other pharmacy staff with drug inventory, purchasing, and receiving. Regularly stocked shelves, rotated stock and checked for expired medications. Performed technical processes required to dispense medications to patients. Assisted the pharmacists with checking in and pricing drug orders, third party transactions and relevant paperwork. Effectively prioritized tasks and organized workflow to increase efficiency.

• CPhT - Certified Pharmacy Technician

  • Jul 2006 - Jul 2010

  Performed regular duties required by NC CVS location.