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Yyyyyy x. yyyyyy

13818 Amiot Drive #A
Maryland Heights, MO xxxxxx
Phone: (xxx-xxx-xxxx
abc@xyz.com


Eager to combine advanced knowledge of the health insurance industry with exceptional business acumen, billing proficiency, managed care experience and social worker credentials toward supporting a dynamic practice in optimizing performance.

 

Qualifications Profile

 

  • Excel in developing, nurturing and maintaining strong relationships with various governmental agencies, health care insurance providers and managed care companies.
  • Accounts Receivable Specialist in billing and follow up on all commercial insurance, Medicare and Medicaid.
  • Specialized knowledge of substance abuse counseling and treatment, mental health issues (bipolar disorder, depression, eating disorders, etc.), crisis intervention, and solution-focused therapy.
  • Equally strong clinical and administrative management skills; proficiency in staffing/hiring, budgeting, sales and marketing, operations leadership, policy and procedure compliance, and insurance/benefits authorization.
  • Deliver unparalleled office and operational support via outstanding prioritization, multi-tasking and report-writing talents; excellent knowledge of health insurance industry
  • Superior blend of organizational, interpersonal, listening, communication and leadership skills.

 

Professional Experience

 

Westchester House/Springbridge Rehabilitation Center - Life Care Centers Of America, 2009 to Present
Assistant Business Office Manager / Accounts Receivable Specialist

  • Drive efficient office operations for long-term care facility with an emphasis in accounts receivable and verification of Medicare, Medicaid, and commercial insurance coverage.
  • Leverage considerable financial acumen toward preparing, providing and/or overseeing payment receipts, cash receipts, daily cash sheet, petty cash, reconciliations, write-offs, refunds, etc.
  • Handle all billing and follow-up for commercial, coinsurance, private, and Medicare/Medicaid insurance.
  • Administer resident trust accounts in strict compliance with state regulations/guidelines for setting up and closing accounts, disbursing funds, and tracking all monetary actions.

 

Dr. Rolando Larice M.D., 2007 to 2009

Office Manager / Billing Specialist

  • Directed and coordinated daily practice operations for psychiatrist with accountability for policy and procedure compliance, financial administration including accounting, reporting and budgeting, and enforcement of payer and reimbursement policies and coding guidelines.
  • Proactively established and maintained cohesive relationship with managed care companies, effectively negotiated rates, facilitated payments for claims, and oversaw patient relations.

 

Self-employed, Rolla, Xxxxxx, 2001 to 2008

Private Clinical Practitioner

  • Provided mental health services to children, adolescents, and adults focusing on a broad scope of issues.
  • Applied dynamic clinical thinking expertise to formulate appropriate treatment plans, integrate community resources as needed, and administer billing functions including Commercial Billing and Medicaid Billing.

 

Continued

 

 

Yyyyyy x. yyyyyy, Page 2 of 2

 

Professional Experience continued


Family Fitness Center, Rolla, Xxxxxx, 2001 to 2006
General Manager

  • Spearheaded daily business operations spanning budget administration, inventory control, staffing/hiring, membership sales, and program management.
  • Directed and motivated staff to deliver exceptional levels of customer service and achieve strict compliance with health and safety requirements.

 

Mental Health Network, Clayton, Xxxxxx, 2000 to 2001
Care Manager

  • Combined administrative, planning, leadership and clinical talents to deliver appropriate and efficient care to patients, cooperating with numerous external agencies and professionals.
  • Functioned as on-call supervisor, exhibiting outstanding crisis management expertise to seamlessly facilitate emergency admissions.
  • Diligently reviewed cases and approved and certified mental health insurance benefits.
  • Trained, motivated and supervised staff members, and served as operations manager in CEO s absence.

 

Magellan Behavioral Health, Maryland Heights, Xxxxxx, 1998 to 2000

Care Manager

  • Expeditiously examined managed care cases to authorize benefits-covered mental care, assess and approve emergency admissions, and participate in intensive case management program assisting high-risk clients.
  • Evaluated and authorized gatekeepers and referrals, requiring strong decision-making capabilities.
  • Developed treatment timeline and ensured plans met specific client requirements.
  • Led investigative efforts to swiftly resolve complaints with both providers and clients.

 

ADDITIONAL EXPERIENCE:

Substitute Teacher, Rolla School District, Rolla, Xxxxxx, 2003 to 2008

Social Worker, Boys and Girls Town of Xxxxxx, St. James, Xxxxxx, 1996 to 1998

 

Education

 

Master of Social Work Degree, Xxxxxx University, St. Louis, Xxxxxx, 1996

Bachelor of Arts Degree, Communication, University of Xxxxxx, Columbia, Xxxxxx, 1988

Licensed Clinical Social Worker (LCSW)

Academy of Certified Social Workers (ACSW)

 

Professional Development 


Licensed Insurance Sales Agent, (Life, Accident and Health), Xxxxxx and Illinois, 2007

Member, National Association of Social Workers C1994 to Present

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