0000 xxxxxx xxxx , xxxx , xxxxx 00000

                                                                                                                                                                        (xxx-xxx-xxxx • abc@xyz.com

Profile of Qualifications

 

Solutions-focused Insurance Professional eager to contribute over 13 years of progressive Contract Coordinator, Provider Relations, Account Management, and Customer Service experience within high-volume insurance groups and healthcare facilities.  Top-performer with the ability to analyze accounts and compile / distribute statistical data to executive-level management.  Excellent communicator who can handle multiple assignments within deadline-driven environments.  Key networker among industry professionals with talent for responding to diverse client issues.  Ambitious self-starter who demonstrates strong attention-to-detail and sharp analytical and problem-solving skills.

 

v  Insurance Knowledge: Contributes expertise in various Health Plans (i.e. Medicare, Medicaid), Provider Relations, Account Management, and Patient Billing, as well as Pharmaceutical, No-Fault, and Workers Compensation Claims.

v  Licensure: Currently pursuing Property and Casualty Licensure with Pat Scanlan School of Insurance (Marietta, GA).

v  Computer Applications: Proficient in Microsoft Windows 2000, Microsoft Office Suite, IDX, SMS and Medical Management Systems, AMISYS, EZCap, and MACESS; willing to learn / master additional programs as necessary.

 

Professional Synopsis

 

         Apply dynamic administrative support abilities toward assisting director and team in coordinating Contract Case Conferences for all health plans to include overseeing contract submission processes to ensure compliance with corporate standards and internal controls.

         Collect, prepare, and distribute statistical data for regular reports, along with communicating compliance with contract submission rules and exception requests to management and updating contract organization databases as required.

         Coordinate annual corporate-wide data verification processes for contracted providers, as well as interfacing with all credentialing staff to guarantee congruency of health plan data systems.

 

         Utilized broad scope of health insurance industry knowledge to handle service and claims inquiries / issues for physicians and office staff to include actively liaising among providers, internal clients, and corporate headquarters to resolve key business challenges.

 

         Proficiently managed past-due patient accounts for diverse physician clientele, along with demonstrating strong communications skills toward networking among Medicare and private insurance companies to obtain status of claims payments.

 

         Obtained critical authorizations from insurance companies for prosthetics and DME to include employing knowledge of workers compensation regulations and managed care insurance company policies to gain authorization for medical equipment.

         Expertly negotiated with insurance adjusters to collect equipment payments.

 

         Maximized organizational efficiency by maintaining billing for healthcare providers, patient accounts, insurance aging and accounts receivable, along with assisting patients and insurance companies by responding to and resolving all-inclusive billing inquiries.

 

         Drove business success by collecting over $50 million within allotted time for no-fault and workers compensation hospital claims.

 

         Performed proficient troubleshooting for wide-ranging pharmacy claims to include handling all member inquiries regarding key pharmaceutical benefits and assisting pharmacies with claims submissions errors.

 

Additional Job History

 

Senior Coordinator, Oxford Health Plans, Iselin, NJ                                                                                                                  1998 C 1999

Anesthesia Medical Biller, AllMed Financial Corporation, Rutherford, NJ                                                                          1996 C 1997

 

Additional Professional Roles Held Prior to 1996