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Experienced Strategic Leader with 12+ years of experience in progressive financial and operations management roles within a variety of industries. Experienced in managing complex medical insurance claims, supervising cross-functional teams, performing account analysis, and providing high level customer service. Equipped with a significant level of communication and interpersonal abilities in addition to a keen ability to develop positive relationships with co-workers, members of management, vendors, and customers.

  Direct daily administrative and operational functions within a fast-paced environment with a focus on increasing productivity and efficiency

  Review/analyze client billing and account transactions in order to ensure accuracy, ensure third-party payor s guidelines are adhered to, and resolve credit balance issues

  Perform follow-up on billed claims in order to ensure timely payment, review reimbursements to ensure accuracy, and resolve billing related discrepancies

  Maintain a keen knowledge of both commercial and managed Medicaid in addition to reviewing claim denial reasons prior to filing appeals

  Instrumental in the management of complex medical claims which included acting as a primary point of contact in the processing of refund requests

  Oversaw claim settlements proposal work queue, performed claim research within the Accounts Receivable System, and assisting client s with claim related inquiries as needed

  Play a lead role in comparing claim requests with client guidelines/requirements and approving and/or rejecting additional information from commercial insurance carriers

  Utilized superior communication abilities in order to complete research on pharmacy claims in addition to pursuing collections for incorrectly paid claims

  Contacted pharmacy carriers in order to track eligibility, tracked outstanding claims for rebills, and ensured claims were paid correctly

  Consistently fostered a positive working environment at all times in addition to providing a high level of customer service to both new and existing clients at all times

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  Guided daily operations within a call center environment with a concentration on performing quality audits and creating weekly phone schedules for staff members

  Supervise a team of 13 staff members which required providing individualized feedback/coaching in addition to diffusing complex employee relations issues

  Successfully diffused escalated and/or sensitive customer calls, acted as a liaison between staff members and executive management, and set-up payment arrangements on behalf of customers

  Handled financial and operations tasks which included completing reconciliations of blue star cash remittances and handling accounts receivable tasks

  Created blue star delinquency letters, implemented grace periods to a minimum value on accounts during reconciliation, and provided telephone support to state specific groups

  Utilized superior analytical abilities in order to review checks for validity along with processing both returned and voided checks

  Performed medical coding and balancing cash refunds, analyzed medical claim documents for processing, and appropriately code FSS inventory

  Led the identification and preparation of documentation in order to handle non-FSS and unidentified items along with performing in-depth claim research