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Yyyyyy x. yyyyyy
0000 xxxxxx xxxx , xxxx , xxxxx 00000
xxx-xxx-xxxx
abc@xyz.com
Health Care Professional
Profile
Offering progressive experience in medical claims, with extensive customer service and management background, and consistent results in achieving fiscal and organizational objectives. Strong leader who excels in training and directing top-performing teams. Effectively establish and manage key relationships with decision makers and strategic partners. Extensive knowledge of CPT, HCPC, RVS, ICD9, Revenue and ASA codes. Proficient in utilizing universal forms, including HCFA 1500, UB92 and UB04, as well as electronically submitted claims and documents.
Policy/Procedure Development Medical Terminology Medicare HMO/PPO Auditing Billing
Medical Claims Processing Customer Service HIPPA & PHI Regulatory Compliance
Coding Pricing Negotiations Training Best Practices Project Management Insurance
Career Background
Operating Engineers/Associated Third Party Administrator (ATPA), Concord, CA 2002-2009
Claims Processor/Examiner and Customer Representative
Contributed industry expertise and dynamic communication skills toward responding to customer inquiries and promptly troubleshooting/resolving issues.
Proficiently processed claims in production-driven environment, with strong focus on optimizing productivity, efficiency and quality.
Audit files for overpayments and underpayments and define and resolve discrepancies to avoid unnecessary cost expenditures.
Performed adjustments, billing and correspondence for various types of claims, including: adjustments, appeals, re-instatement, re-insurance, inpatient/outpatient/emergency hospital, radiology, laboratory, medical, vision, Medicare, prescriptions, anesthesia, capitation, HMO, PPO, COB and TPL claims.
Consistently met and/or exceeded company goals by ensuring critical compliance with all laws and regulations as well as company policies and procedures.
Maintained up-to-date on new and required materials and current industry news/trends to ensure accuracy.
Worldwide Painting 1997-2002
Project Manager/Office Manager
Concurrently managed all aspects of multiple projects from inception through completion, demonstrating exceptional multitasking and prioritizing abilities in achieving goals and timelines.
Spearheaded requirements gathering, project scope development, resource allocation/administration, budgeting, and project team management.
Promoted superior service and exceptional customer satisfaction by promptly resolving issues and preventing escalation.
Led meetings to review current/updated project plans and proactively identify and resolve problems.
Strategically planned and coordinated schedules to maximize use of resources while controlling costs and meeting company needs.
Efficiently organized workflow, defined project requirements and delegated assignments to optimize utilization of human capital and operational resources.
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Yyyyyy x. yyyyyy Page 2 of 2
Career Background continued
Hill Physicians Medical Group 1990-1997
Clams Supervisor
Exhibited solid leadership qualities in managing, auditing and processing adjustments, appeals, re-instatements, inpatient/outpatient/emergency hospital, radiology, anesthesia, prescriptions, laboratory, medical, vision, Medicare, capitation HMO, PPO,COB,TPL and Indemnity claims.
Applied expertise in the Referral and Authorization process and in tracking production and quality as it relates to claims within standards for quantity and quality.
Successfully built top-performing personnel vital to supporting enterprise-wide operations by strategically recruiting and effectively interviewing, screening and testing candidates.
Trained, motivated and evaluated staff, playing an instrumental role in the development of top performing team members.
Built and established key relationships and liaised effectively with senior management, staff, vendors, and external and internal clients.
Additional Experience
Main Operator/Customer Service/GiftWrap Associate - Macy s Federated
Project Manager - Charles Schwab
Lead/Claims Processor - NorthWestern National Life Insurance
Lead/Claims Processor - TransAmerica Life Insurance
Professional Training/Development
Select Business Courses - College of San Mateo, San Mateo, CA
Numerous Management Seminars
Technical Skills
IBM Claims Processing System, Well Point/Blue Cross Claims Processing System, Electronic Claims Processing, MS Project 98-2000, Office 95-2000, Excel, Access, Word, PowerPoint, Visio, Internet/Intranet, Outlook, Lotus 123, HMO, PPO, COB, TPL, Re-instatement, Re-insurance, Appeals, Adjustments, Medical, vision, Dental, Radiology, Laboratory, Anesthesia, Prescriptions, Hospital, Medicare, Claims Insurance Processing Experience, Medical Terminology, HCPC, ICD9 and CPT codes, Distributed, Mainframe Environments, Cash Register, 10-Key and different types of claims organization systems
Community Service
Volunteer - Feed the Homeless, Mother Wright's Foundation, Oakland, CA
Yyyyyy x. yyyyyy
0000 xxxxxx xxxx , xxxx , xxxxx 00000
xxx-xxx-xxxx
abc@xyz.com
Date
Contact Name, Title
Company Name
Address
City/State/Zip Code
Dear__________________:
I am currently exploring new career opportunities and to acquaint you with my qualifications, I am submitting my resume for review. In advance, thank you for your time and consideration.
As demonstrated in the accompanying resume, I offer a comprehensive background in customer service, medical claims processing and management, with a strong track record in driving operations to generate solid results. From leading high performance teams and facilitating superior client servicing to streamlining operations and executing proactive organizational processes/procedures, I have continually excelled in maximizing performance as a dynamic leader. I excel in identifying and resolving inefficiencies, introducing solutions instrumental to boosting performance and strategically utilizing resources to generate optimal results.
As a member of your team, I will consistently exhibit a strong commitment to quality and a dedication to playing a large role in achieving and surpassing goals. I am eager to meet with you to discuss how my qualifications support your current and prospective needs, and welcome the opportunity to interview at your earliest convenience.
Professionally,
Yyyyyy x. yyyyyy
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