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yyyyyy x. yyyyyy                                           0000 xxxxxx xxxx , xxxx , xxxxx 00000

(xxx-xxx-xxxx

abc@xyz.com

objective

healthcare insurance professional with expertise in non-clinical medical operations, medical billing, admissions, claims management and vendor operations, eager to contribute toward defining, integrating and launching innovative reliability/productivity solutions.

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career profile

ø  over 20 years experience in all phases of healthcare administration, operations, business development and program management.

ø  expertise in managing outside claim vendors.

ø  knowledgeable in sarbanes oxley regulatory requirements.

ø  ensure claims processing in timely and accurate manner.

ø  coordinate with medical management to facilitate file accuracy and validity.

ø  develop and execute effective policies/procedures.

ø  record of progression to assignments of increasing authority and responsibility.

ø  exceptional communicator and third party administrator.

ø  outstanding team leadership and customer relations skill sets.

ø  capacity in full life cycle project management.

ø  skilled in marketing and program enrollment initiatives.

ø  contribute effectively to revenue growth and p&l.

ø  expert in research and analysis focusing on revenue expansion.

ø  notable communication and presentation abilities.

ø  adept in management, personnel mentoring and meeting professional standards.

ø  proficient in advanced business software applications.

ø  well-organized multi-tasker with exceptional interpersonal skills.

ø  university-level management training.

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professional experience

healthnet insurance company, shelton, ct                                                                        1999 c present

vendor operations management (2005-2008)

       manage outside claim vendors hns (health network systems).

       perform daily review of sox (sarbanes oxley) reports for import/export files.

       conduct continuous testing of extracting files and validating that claims are extracted regularly.

       act as troubleshooter when files fail validation. 

       coordinate with medical management when contract files in hns (health network systems) are tested.

       product payment issue resolutions with hns.

       implement policies/procedures of hns and teamed with itg, project managers and directors on project.   

       facilitated weekly meetings with outside vendor and internal associates to manage hns issues.

       direct healthnet savings post payment performed through hns. 

       aided development of hns medical record reviews based on age gender diagnosis and procedures, to ensure hospitals are billing correctly/receiving proper payments.

       successfully reprocessed claims and authored provider letters on financial findings.

       report was tracked monthly, quarterly and annually, then presented to all claims supervisors, managers, directors and vps.    

       direct monthly meeting with quality department and hns quality department to review statistical results. 

       research errors to determine if resolution could occur at vendor or healthnet.

       originated multiple scenarios to correct frequent issues.

       orchestrate all policy/procedures for hns disputes from providers.

       department representative for all government/state mandates including communications to team. 

 

 

yyyyyy x. yyyyyy

page two

 

 

claims supervisor (2003-2005)

       advanced to supervisor of government claims and benefits coordinator.

       directed 32 employees and oversaw attendance, hiring and policy/procedures.

       administered daily claims inventory operation.

       managed staff to cover specific claims due to high claim inventory. 

       originated monthly reports covering claim inventory-beginning of month, claim inventory-end of month and increase/decrease of claim inventory.

       authored and developed charts to show increase/decrease in claims inventory.

       responsible for departmental production and quality.

       facilitated meetings with it, medical management and quality departments to improve claims processing.

 

claims department team lead (2002-2003)

       tasked to work directly for claims supervisor and manager.

       served in team liaison role aiding claims processors with difficult claims.

       interpreted contracts for payment of claims. 

 

 

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earlier background

prior to 2002, served healthnet as research and adjustments processor and claims processor.  other career positions were as medical management coordinator, oxford health plans, trumbull, ct, admissions coordinator, bridgeport hospital, bridgeport, ct, and emergency room/admissions coordinator, middlesex hospital, middletown, ct.  in these assignments, built outstanding project management, claims processing, medical records, admissions and emergency room operations skill sets.

 

 

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education

sacred heart university, bridgeport, ct

management and supervisory studies

 


yyyyyy x. yyyyyy                                           0000 xxxxxx xxxx , xxxx , xxxxx 00000

(xxx-xxx-xxxx

abc@xyz.com

 

 

 

cover letter text

 

date

 

 

 

hiring agent name

title

company name

address

city, state   zip code

 

dear                   :

 

i am currently seeking a challenging career opportunity in a manager/supervisor, medical administration capacity and am submitting my resume for your review.  in advance, i thank you for your time and consideration.

 

as demonstrated in the accompanying resume, my professional qualifications include over 20 years of successful background in the healthcare insurance and hospital sectors.  to complement this background, i possess demonstrated expertise in medical billing, admissions, outside claim processing, file testing, troubleshooting, validation and payment coordination, as well as strong analytical, problem-solving and managerial capabilities.  as an employee, you will find me to be an enthusiastic and disciplined team player, committed to supporting you in achieving your objectives through superior performance. 

 

i am confident that i could be a valuable asset to your firm, and look forward to interviewing with you in the near future to further discuss my areas of experience and expertise that would be a contribution to your organization.

 

 

 

 

sincerely,

 

 

yyyyyy x. yyyyyy

 

 

attachment

 

 

 

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