Experience

FROEDTERT & MEDICAL COLLEGE OF WISCONSIN

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Cancer Center Scheduling Coordinator

  • Nov 2017 - Present

  Operate all aspects of a multi-disciplinary outpatient clinic in the Clinical Cancer Center. This includes a high degree of patient interaction including coordination of care and scheduling all tests, treatments and visits within the cancer center. Insurance authorization for radiation therapy. Creation and maintenance of the department schedule and triage of a high volume of incoming telephone calls. • Essential role in opening a new Cancer Center clinic. • Trained to be a Super user for EPIC. • Preceptor/Trainer for new employees. Show less



Rehab Management Solutions

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

• Account Mananger

  • Feb 2016 - Nov 2016

  Adjudicate claims payments in Medical Manager and AdvancedMD. Research improper payments and submit to insurance. Manage account receivables. Research and compile documents to file appeal. Active in patient support, benefits and collections. • Adjudicate 50 to 100 claims per day with 100% accuracy. • Increased revenue by 50% within the first 90 days of hire. • Identified and created new protocols for workflow inefficacies. Adjudicate claims payments in Medical Manager and AdvancedMD. Research improper payments and submit to insurance. Manage account receivables. Research and compile documents to file appeal. Active in patient support, benefits and collections. • Adjudicate 50 to 100 claims per day with 100% accuracy. • Increased revenue by 50% within the first 90 days of hire. • Identified and created new protocols for workflow inefficacies.



Oral Surgery Associates

• United States
• Medical Practices
• 1 - 100 Employee

• Insurance Coordinator

  • Feb 2015 - Feb 2016

  Adjudicate claims payments in WIMOS. Research improper payments and submit to insurance. Manage account receivables. Verify benefits and draft estimates for patients prior to services being rendered. Research and compile documents to file appeal. Adjudicate claims payments in WIMOS. Research improper payments and submit to insurance. Manage account receivables. Verify benefits and draft estimates for patients prior to services being rendered. Research and compile documents to file appeal.



Anthem, Inc.

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

• Performance Quality Auditor

  • Jul 2013 - May 2015

  Audit claims contractors of Affordable Care Act for medical insurance payment, coding, processing and procedural accuracy. Complete rebuttal and appeal processes. Conduct simultaneous audits for multiple regions and claim types. Develop and present inaccuracy reports for Business Department and Managers using Lync and Outlook. Provide training, mentoring and support to new employees. • Reduced inaccuracies by identifying, tracking, documenting, and reporting issues and inaccuracies. • Created collaborative environment by communicating with other departments and vendors via SharePoint and Lync Meetings. • Audited 255 claims monthly with 99% accuracy rate, maintaining mandate set by Affordable Care Act. Show less



National Government Services

• Insurance
• 700 & Above Employee

• Quality Training Specialist

  • Jul 2010 - Jul 2013

  Provide an accurate and efficient trainingprogram to the TRICARE audit department. Perform quality assurance reviews includingresearch and analyzing claim adjudication. Provide feedback and coaching on the results ofthe reviews. Support for new employees and existing staff. Implement changes and trainstaff. Develop training programs for existing and new products. Maintain departmentreference materials.

• Quality Auditor

  • Jul 2010 - Jul 2013

  Analyze and evaluate claims to determineaccurate and appropriate claims processing for all of TRICARE, the United States Militaryinsurance, including Dental, Health, Pharmacy and the members Overseas.



Lakeview Pharmacy

• United States
• Pharmaceutical Manufacturing
• 1 - 100 Employee

• Billing/ Compliance Officer

  • Mar 2008 - Jan 2011

  Accounts Receivable. Troubleshot unpaid claims. Generate monthly statements. Active in payment collection process. Generate monthly account reports for clients. Process claims electronically and paper form. Compliance Officer for Medicare Part B and Fraud Waste and Abuse. Accounts Receivable. Troubleshot unpaid claims. Generate monthly statements. Active in payment collection process. Generate monthly account reports for clients. Process claims electronically and paper form. Compliance Officer for Medicare Part B and Fraud Waste and Abuse.



North Shore Asthma and Allergy

• Front Office Supervisor

  • Aug 2007 - Dec 2007

  Manage six employees in the front office of a five physician asthma and allergy clinic. Assist in hiring new employees. Liaison between the physicians, the billing office, nursing staff and the front office staff. Schedule patients, check patients in and out, answer a multi-line phone, call in prescription to pharmacies. Manage six employees in the front office of a five physician asthma and allergy clinic. Assist in hiring new employees. Liaison between the physicians, the billing office, nursing staff and the front office staff. Schedule patients, check patients in and out, answer a multi-line phone, call in prescription to pharmacies.



WellPoint

• Insurance
• 1 - 100 Employee

• Grievance and Appeals Representative

  • May 2004 - Apr 2007

  Grievance Associate. Investigate grievances regarding denial for referrals, treatment and claims payment. Compile, proof and process confidential documents. Prepare and present cases to a panel of medical directors, attorneys and laymen for reconsideration of denials. Create, file and route highly confidential medical correspondence and other records. Maintain an excellent relationship with internal and external individuals. Maintain case timeliness reports for Management. Order office supplies. APS Healthcare August 2002-May 2004 Special Medical Reviews Coordinator. Compile, proof and process confidential documents. Prepare and present cases to a panel of medical directors, attorneys and laymen for reconsideration of denials. Create, file and route highly confidential correspondence and other records. Maintain a log of all denials and appeals that flow through the department. Compliance with the HIPPA, URAC, ERISA and the Department of Labor laws. Communicate well with internal staff and external individuals. Assist the doctors as a medical assistant. Take history and physical information, vital signs, prepare chart for the doctor.; to various clients regarding the managed care through their insurance company. Answer a multi-line phone. Gather and coordinate clinical and non-clinical information. Conduct investigation and research to resolve customer inquires. Show less



ADVANCED PAIN

• United States
• Medical Practices

• Insurance Specialist

  • Apr 1999 - Feb 2002

  Effectively utilize my skills to create contacts in the insurance profession to gain authorization of patients' procedures. Type letters to various professionals in the medical field. Work as a team with the other departments, physicians and patients to deliver the best medical care. Assist with medical presentations; create slide presentation, correspond with participants in writing and via telephone. Effectively utilize my skills to create contacts in the insurance profession to gain authorization of patients' procedures. Type letters to various professionals in the medical field. Work as a team with the other departments, physicians and patients to deliver the best medical care. Assist with medical presentations; create slide presentation, correspond with participants in writing and via telephone.