Yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx ● abc@xyz.com

Benefits Administration ~ Project Coordination ~ Human Resources

Appeals / Denials ~ Accounts Payable & Receivable ~ Records Management

         Offer 20 years experience in healthcare administration encompassing medical office operations, patient relations, customer service, billing, coding (CPT, ICD-9), switchboard operations, transcription, and insurance.

         Well-versed in medical terminology and Medicaid, Medicare, and third-party reimbursement regulations.

         Excel in analyzing existing healthcare practices and implementing process improvements to elevate patient satisfaction while controlling expenses.

         Excellent computer skills; proficiently maintain forms and databases to track vital information, and able to quickly master new software applications.

         Reliable and ethical with a solid reputation for commitment to confidentiality.

         Adept at simplifying workflow processes and effortlessly maintaining large volume of files.

         Dynamic communication skills; able to establish effective working relationships with all levels of an organization.

Resource One Administrators, Tulsa, OK, 2015 to Present

Project Manager

         Spearhead online employee benefit system for 10 accounts concurrently by obtaining required information for plan building, conducting weekly calls with clients/plan builders/brokers, and maintaining up-to-date project plans.

         Test client sites for quality assurance, track and monitor issue resolution, and serve as primary point of contact for clients, internal team members and partners.

         Systematically audit carrier files for open enrollment and join forces with carriers to implement changes as needed.

         Interview, hire, train, coach, and motivate detail-driven and personable support staff.

         Provide technical guidance throughout full implementation of new client web sites.

         Continually update sites to reflect benefit class matrix, requirements document, rates, permissions, and field options.

         Prepare and deliver presentations and trainings including open enrollment demonstration for new/changing plans, site text, and release functionality changes.

         Proactively streamline workflow related to setup and maintenance of carrier and payroll feeds.

Tulsa Spine and Specialty Hospital, Tulsa, OK, 2005 to 2015

Precertification Clerk / Financial Counselor / HIM Clerk

         Verified insurance benefits and obtained service authorization prior to patient admission.

         Contacted insurance companies regarding discrepancies in payments when necessary, and diligently followed up on unpaid claims.

         Solicited authorizations for surgical procedures, responded to inquiries from patients or insurance companies, and facilitated filing of appeals to insure proper payment of services.

• Coordinated transcription and medical record processes according to stringent Medicare, Medicaid, and Workers' Compensation criteria.

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Medical Professionals LLC, Tulsa, OK, 2003 to 2005

Medical Insurance Clerk (temp)

         Acquired insurance authorizations for procedures and tests ordered by attending physician and extensively supported administrative tasks associated with hospital admissions.

         Steered seamless patient registration process by meticulously validating patient information, collecting co-pays, and verifying insurance details.

         Methodically orchestrated charge submission through electronic charge capture, including billing & account receivables (BAR) system and clearing house.

Suzanne Bruce & Associates, Houston, TX, 2002 to 2003

Insurance Specialist

         Resourcefully instituted policy to streamline insurance verification process, and independently oversaw insurance verification activities for practice comprising four physicians.

         Maintained accurate and up-to-date referral information in computer system and generated monthly reports for A/R department.

New Era Life Insurance Company, Houston, TX, 2001 to 2002

Customer Service Representative

         Applied strong organizational skills toward responding to high-volume calls from insurance providers and plan participants, and leveraged advanced knowledge of PPO, HMO, POS, TPA, Medicaid, and Medicare to accurately guide callers in proper claims procedures.

Obstetrical & Gynecological Associates, P.A., Houston, TX, 1997 to 2000

Office Coordinator

         Performed the complete spectrum of administrative functions encompassing accounts receivable, bank reconciliations, documentation of incoming payments, spreadsheet development to track missing charges, and distribution of monthly reports to multiple physicians.

Prior Background:

Front Office Clerk, Dr. Leigh Z. Naftolin, Houston, Texas

A/P & A/R Clerk, Columbia West Houston Surgicare, Houston, Texas

Associate of Science, Psychology (in progress)

Tulsa Community College

Associate of Applied Science, Pre-Nursing

Oklahoma State Institute of Technology

NextGen, Microsoft Office Suite, FastTrack, Medisoft,

Medical Manager, Misys Tiger, POS systems