Yyyyyy x. yyyyyy

Xxxxxx, XXXXXX xxxxxx ￨ (xxx-xxx-xxxx ￨ abc@xyz.com

Financial Healthcare Administration ￨ Insurance / Medical Billing ￨ Full-Cycle Accounting

Administrative Management ￨ Team Building / Training ￨ Process Optimization ￨ Vendor Relations

Client / Provider Relations ￨ Conflict Resolution ￨ Workflow Prioritization ￨ Multi-Project Management

CPT / ICD-9 / HCPCS Coding ￨ Claims Handling ￨ Intake / Pre-Authorization Requests ￨ Appeals / Grievances

Account Management ￨ Regulatory Compliance ￨ Strategic Analysis ￨ Trends Tracking ￨ Business Communications

Highly Accomplished MHA Candidate who makes sound decisions to reflect positively on healthcare facility operations in alignment with a company s financial, billing, and revenue goals to drive profit-, quality-, and service-focused initiatives. Top Performer who offers solutions-centric critical thinking for insightful, change-oriented results. Out-of-the-Box Thinker who rises above financial / billing challenges to improve the bottom line and achieve winning outcomes, including quickly adapting to evolving scenarios. Excellent Communicator who develops synergistic relationships with administrative teams, healthcare professionals, insurance providers, and patient / clients, and who leads peers by example and with ethics and integrity.

Career Highlights Include:

  Contributing strong multitasking skills and solid attention-to-detail.

  Exhibiting recognition as a quick study who rapidly picks up new concepts.

  Achieving recognition for reducing AR days and maintaining a clean claim system.

  Offering proven experience within insurance / medical billing and accounting fields.

  Cross-functionally collaborating with peers to deliver high-quality administrative services.

Billing ￨ Accounts Receivable Manager

Capitalize on the opportunity to lead forward-thinking billing and accounts receivable initiatives, including reviewing, preparing, and transmitting DME billing electronically and via paper, as well as running aging reports to monitor collectable revenue and recording incoming vendor and administrative invoices. Run monthly patient statements, along with preparing insurance / patient adjustments and refunds. Perform essential intake and pre-authorization requests for new DME orders and assign delivery to an appropriate clinical representative. Promptly file appeals and grievances to insurance carriers for denied claims, along with responding to patient billing needs. Issue payments for vendors and administrative / operations expenses.

  Serve as project manager in manual implementation and conversion of billing platform.

  Lead a details-centric, 2-member staff in performing accounts receivable and collections.

Healthcare Financial Administrator

Strategically steered financial administration, including interfacing among vendors regarding accounts payable and purchasing while reconciling statements and expense reports. Performed bi-weekly check runs.

  Supported controller with special projects to actively meet and / or exceed financial objectives.

  Exhibited skill with QuickBooks and Great Plains for accounts payable / receivable and purchasing.

Senior Follow-Up Consultant ￨ Administrative Assistant

Utilized broad scope of industry knowledge toward proactively following up on accounts for Xxxxxx Medicaid, MCO, and various PPO / HMO insurance plans, including contributing expertise with Intuit QuickBooks on all accounts payable / receivable, general ledger, and sales / PO modules. Efficiently ran insurance claims, patient statements, and budget plans for timely mailing by staff.

  Collaborated with department manager for special projects and new staff training.

  Nominated by management as a go-to contact for multi-carrier provider representatives.

  Rapidly transitioned to specialized work, including large-scale appeals on key Excel spreadsheets.

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Medical Biller ￨ Follow-Up Consultant

Delivered solutions-focused account follow-ups for primary care and physical therapy practices, including overseeing accounts 30 to 180 days in accounts receivable for prompt attention. Resolved patients account issues while posting charges and payments and filing appeals as required.

  Consistently handled follow-ups for HMO / PPO, Medicare, and Medicaid plans.

  Ensured seamless administrative processes throughout weekly telecommute days.

Medical Biller

Led targeted medical billing processes for Rockville- and Olney-based vascular labs, including performing insurance follow-ups to obtain payment due for services rendered. Handled bank deposits and recordkeeping.

  Efficiently posted high-volume charges, payments, and adjustments for both offices.

Claims Auditor

Expertly reviewed pre-paid / paid dental claims for payment and processing errors, including entering quality statistics into database and advising management of current error trends. Adjusted incorrectly paid claims.

  Proactively supported Member / Provider Services in resolving key claims challenges.

  Liaised among dental consultants concerning members questionable dental treatment.

Senior Claims Adjuster

Contributed sharp analytical abilities toward handling payment of medical, dental, and prescription benefits for both PPO and co-pay plans for diverse insured groups, including processing adjustments to incorrectly paid claims. Promptly handled phone-based customer service requests for 50+ plans offered by company.

  Trained and mentored newly hired claims examiners and customer service representatives.

  Collaborated with staff physicians regarding recertification and acceptable treatment matters.

Claims Research Examiner

Played a vital role in analyzing and approving payment for medical claims (i.e. high-dollar, foreign) while demonstrating comprehensive knowledge of CPT, ICD-9, and HCPCS codes. Supported resolution of open season and quality control issues. Reviewed aging reports for timely insurance filing limits and paid charges.

  Continually led troubleshooting of computer lockups and PC inventory logging.

Master of Healthcare Administration (Projected Winter 2018)

Bachelor of Science in Accounting

Certified Professional Coder (CPC) AAPC (Certification Studies in Progress)

Microsoft Dynamics GP ￨ Intuit QuickBooks ￨ Microsoft Office (Word, Excel, PowerPoint, Outlook)