To obtain a position in the industry to best utilize my acquired skills in the areas of Network Management, Provider Relations, Insurance Sales/ Support, Physician Credential Management, Physician Practice Transition, Sales and Technical Specialist within the Insurance/Healthcare Industry.
I have over 20 years experience in technical support within the Health Insurance Industry. My experience includes Medical Practice Management, Provider Relations, Network Management Administration, staff training, maintaining sensitive accounts, preparing written correspondence, system adjustments and computer operations, troubleshooting benefits and billing problems, determining rate structures, researching and verifying client information, claims processing, collections and serving as liaison between sales representatives, field offices, and company representatives.
I am a licensed Accident & Health/Life Insurance Producer.
Computer systems include Handstar II, RIMS, ASA, ERISCO and AMPS.
Knowledge of Medical Terminology, Worker's Compensation, Short-Term Disability, medical benefits, policy interpretation, state and federal regulations, policy language and most all aspects of business office operations. I have excellent organization, communication, and interpersonal and problem solving skills.
Insurance Network Management, LOMA and FLMI Insurance Training, Principles of Life & Health Insurance and Operations, Medical Terminology, Anatomy, Specialized Computer Applications, Service Excellence Skills & Strategies. Accounting (Chattanooga State Technical Community College, Chattanooga, TN). No Degree.
Computer Training: MS Word (Beginning, Intermediate, Advanced) and MS Excel (Beginning, Intermediate, Advanced)
01/02/2007-Present - EDI Analyst-Unum Provident Insurance Company, Chattanooga, TN
Principal Duties and Responsibilities: Â· Gather, analyze, and document client's EDI requirements using proprietary and standard (ANSI X12) layouts to include but not limited to (Medical, Dental, Vision, Payroll, STD, LTD). Â· Analysis include: o File format and detailed field level analysis o Interaction of data with business needs o Reconciliation of data interchanges between our system, customers, and other third-party systems. o Define data distribution mechanism o Develop production operation plans Â· Work with the channel partners to define, test, and implement. Â· Provide technical support to new and existing customers. Â· Work closely with BA Client (Implementation) Managers to develop project plans, events, and schedules. Â· Identify and perform process improvements related to data exchange process. Â· Create edit checks and error reporting process related to the data interchange process. Â· Negotiate agreements for on-going data distribution with the customer and third-party vendors.
02/2006-01/2007- Practice Administrator- The Center For Restorative Medicine, Hendersonville, TN (Last Name: Brauer)
Responsible for setting up an entire new physician's practice including hiring personnel, physician credentialing, payroll, setting up vender accounts, installing and learning Quick Books accounting system, MacPractice record keeping system and SpringCharts patient charting system. Vender accounts include ordering and setting up all office equipment (including computers, printers) ordering medications, supplements, nursing and office supplies. I was responsible for every aspect involving the physician's practice.
Responsible for administering Medicare policies and provisions in the Medicare Hospital Claims environment. Certification for 2006 Part D Medicare Administration. Prior to leaving HealthSpring I was hired to do a report and complete audit of the company's COB system.
I was a Network Administrator for HealthNetwork Systems and started with the company in Feb. 2001. I was responsible for the overall management of network relationships which included initiating and coordinating meetings with the networks to review the type of information I was to receive and file formats for both demographic information & fee schedules. Writing the file formats for programming and then working with an assigned programmer in an ongoing process to load the demographics into the system, analyze the data, testing it to be sure it updated correctly and then repeating that process with the network fee schedules. I also worked with programmers to develop any program enhancements. The testing of the fee schedules involved working closely with the claims area to make sure the claims repricing was correct. I held monthly meetings with the contracts area and the data administrators who were associated with my assigned networks to address any network changes or issues discovered during the month. I kept close relationships with the networks themselves in order to resolve any issues, be informed of any changes and just maintain a great rapport. I maintained progress and any changes for the networks through the e-Trak project tracking system. I received monthly updates and prepared/exported extracts back to the networks at the end of every month. The extracts themselves also had to be carefully monitored and tested to be correct. I also handled the troubleshooting from the networks, contracts area and claims area.
2000-2001 Account Executive - Passport Health Communications - Franklin, TN
Sales and Service - Provided communication solutions to health care organizations by reducing the costs and hassles of health care administration utilizing the power and flexibility of the Internet.
1999-2000 Practice Transition/Credentialing Manager - HCA Columbia Physician Services - Chattanooga, TN
Handle all aspects of credentialing and practice transition for new hire and current physicians within a group of 65+ health care providers. Including all transitions between Medicare, Medicaid and all Commercial Carriers.
Management of local territory of nine counties (1,000+physicians and 12 hospitals). Liaison for providers to all claims offices throughout the country. Handle all claim issues and troubleshoot credential issues. Orient providers to new policies and procedures. Conduct in-services for new providers. Recruit providers into the insurance network.
1995-1996 Claim Specialist-Claim Services Resource Group - Conyers, GA
Temporary assignments in all aspects of insurance operations. Travel assignments include John Hancock, Boston, MA. The State of Louisiana, Baton Rouge, LA and United HealthCare, Birmingham, AL.
Administered approximately 650 contracts monthly. Responsibilities included sales support, client relations, personnel management and training, determining rates for surgical procedures, troubleshooting benefit and/or group billing problems, policy interpretation, researching and verifying claims information, facilitation of HMO/PPO networks, collections, assisting management with cases as needed and serving as liaison between sales representatives, field offices, company reps., healthcare providers and insurers.
1979-1985 Claims Examiner - Blue Cross Blue Shield - Chattanooga, TN
Claims processor handling Worker's Comp. medical claims for the State of Tennessee Employee contract.
References available upon request.
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