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Administrative Support Experience

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I have over 25 years in Management, customer service and administrative support experience. I leverage my excellent supervisory/management skills as well as telephone and interpersonal skills, I utilize knowledge of CPT, ICD-9-CM and HCPCS coding while relying on data supplied from the states to interact with State and Provider contacts to request medical records and ensure that legible and applicable recipient records are available to the reviewers. I have the necessary qualifications and knowledge of the job to be performed and its components for the overall function of the position. Through my past experiences, I have developed a proven ability to effectively work individually as well as in a supervisory capacity, and can effectively communicate …show more content…

Collects and reviews all patient insurance information needed to complete the billing, collections, appeal, and/or cash processes. Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payers. Researches and resolves any electronic claim denials. Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly. Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers. Independently analyzes, reports, and communicates any reimbursement trends/delays (e.g. billing denials, claim denials, pricing errors, payments, etc.). Processes any necessary insurance/patient correspondence. Prior Authorizations .Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians. Coordinates with inter-departmental associates to …show more content…

I was available to answer any questions about workflow, coding, special procedures, and resolution of any issues or problems as they arise, as well as coaching and mentoring team members. I ensured HIPAA compliance was followed. I supported our training unit both in the classroom and our Telephone Research Center (aka Telephone Call Center). A significant part of my responsibilities included the verification of abstraction performed by Data Collection Specialists as well as telephone monitoring. I worked closely with the teams to assist with all questions and review of materials. I worked with hospital administration, physician offices, home health providers, pharmacies, VA-Tri Care providers on a daily basis. Before being promoted to a supervisory position, I went from role play to abstraction based upon my 20 plus years experience in the insurance industry. As an Abstractor, I was assigned to the high and mega burden cases abstracting both medical records (ICD-9) and patient accounts (CPT4) (UB92) (UB04) (EOB). I am familiar with all Federal, State, and Managed Care requirements for billing as well as reimbursement. I was responsible for signing timesheets and assuring all employees adhere to our company policy and procedures. I was responsible for knowing and

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