Manager - Healthcare Resume Search
Manager - Healthcare Resume Search
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Manager Resume


Desired Industry: Healthcare SpiderID: 79431
Desired Job Location: Irvine, California Date Posted: 6/20/2017
Type of Position: Full-Time Permanent Availability Date:
Desired Wage:
U.S. Work Authorization: Yes
Job Level: Management (Manager, Director) Willing to Travel: Yes, Less Than 25%
Highest Degree Attained: Masters Willing to Relocate: Yes


Experience:
DaVita, Irvine, CA
Patient Resource Representative 2015–Present
HIPP Liaison 2013–2015

Western Dental Corporate, Santa Ana, CA
EDI Biller 2011–2013

Landmark Medical Management, Ontario, CA
Worker’s Compensation Biller 2010–2011

Summit Career College, Colton, CA
File Clerk 2009–2010

La Sierra University, Riverside, CA
Secretary 2005–2009

Del Taco, Hesperia, CA
Cashier 2004


Education:
Master of Business Administration: 2016
University of Phoenix, Tempe, AZ

Billing and Coding: 2010
Summit Career College, Colton, CA

Bachelor of Science in Exercise Science, Scientific Basis: 2009
La Sierra University, Riverside, CA


Skills:
Technical Skills

Microsoft Office Suite | Medisoft | Medical Terminology | Medical Billing and Coding
Emdeon and DentalXchange | International Classification of Diseases (ICD-9)
Current Procedural Terminology (CPT-4)


Additional Information:
Summary of Relevant Experience

Healthcare Office Administration
Promoted teamwork for process improvement by building effective interdepartmental communications.
Rendered support to 152 offices by serving as the claims analyst, responsible for improving communications; minimizing uncollectible and to collect first time claims; and managing billing and rebelling of over 1800 workers’ compensation claims every week.
Attended to all aspects of interdepartmental billing and rebelling more than 1800 worker’s compensation claims every week.
Utilized interpersonal skills in managing direct connection between programmers; as well as in attending queries regarding EOBs, patient appeals, verification procedures, and frequencies concerns.
Held accountability in validating benefits, processes, and in-network fee schedules.
Administered maintenance of approximately 130 commercial plans for Southern California, Minnesota, Oregon, and Utah regions through American Kidney Fund (AKF).
Coordinated with Marketing, Intake, Verifying, and Billing and Collections to create protocol in ensuring payments.
Displayed proficiency in operating business office machines.

Customer Service
Performed on-time assessment on each account which was eligible to claim Medicare Bad Debt (MCBD).
Expertly worked with patient population possessing Medicare as primary insurance.
Offered expert and constructive feedback to a new billing system with the purpose of assisting the Patient Resource Team.
Assisted the social workers and patients with the PFE processes as well as in supporting patient calls regarding billing issues and insurance inquires.
Rendered direct support to a team in collecting approximately $198M in 2016 in MCBD.

Patient Account and Cashier Management
Supervised more than 1200 patients’ monthly premium accounts by using AKF.
Provided assistance to insurance counselors (IC) and social workers in maintaining coverage for commercial insurances through AKF utilization and within the state of Southern California, New Mexico, and Utah.
Addressed questions relevant to applications, bills, and amounts, through email and phone calls within four hours.
Held responsibility in closely monitoring patient accounts to guarantee on-time payment for primary and secondary insurance coverage.
Kept abreast of the work load and database for field reports generation, including weekly patient submission report (PSR).

Systems Training and Development
Regularly updated the knowledge on diverse insurance behavior by state and insurance type.
Reviewed state behaviors upon the development of an in-depth training manual for every insurance type.
Managed training of 40 staff regarding the procedure on how to process electronic claims utilizing DentalXchange system, as well as on new systems and protocols while maintaining workload.
Supported field teammates on new and improved processes by training through webinar, together with strong follow-ups to guarantee changes were implemented effectively.
Led the system development to obtain and store student dorm information for future use.
Provided full assistance to several pilot programs throughout the career.


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