CAREER OBJECTIVE

To secure a leadership role with an innovative healthcare system leveraging 13 y

ears patient finance and insurance experience, education, and leadership abiliti
es.
EXPERIENCE
Provider Service Analyst - Sep. 2009 - Present
Arbor HealthCare, Franklin, TN
Travel to area hospitals performing credit audits, recovering overpayments for h
ealth plan clients. Examine and analyze patient accounting records to determine
financial status. Build and maintain business relationships with hospitals, heal
th plan clients, and office staff. Prepare reports for management concerning sco
pe of audit, financial conditions, and source and application funds. Make recomm
endations regarding system and procedural enhancements. Research, resolve, and m
onitor discrepancies found in the credit reconciliation process.
Insurance Specialist - May 2008 - Apr. 2009
MetroHealth Medical Center, Cleveland, OH
Provide guidance, assistance, orientation, and developmental and educational tra
ining. Coordinate appeal process and develop procedures to address systematic de
nials. Analyze account receivables to identify timeliness and inequities in paym
ents and work toward resolution. Creates and revises charge documents for profes
sional and technical charges. Monitor and resolve claims in edit hold reports. E
xperience with SMS/HBO, Epic (Resolute, Tapestry, and EpicCare), OnBase, RASW, a
nd Quadax.
Medical Claims Examiner - Feb. 2006 - Apr. 2008
Travelers Insurance, Independence, OH
Analyze evidence, applicable law, regulations, and policies to coordinate claims
adjudication. Interview witnesses to obtain information relevant to motor vehic
le injury claim. Notify parties of claim status, appeal rights, and preparation
of written opinions and decisions. Authorization of valid claims payments and de
nials. Experience with Impact, Access, and Dashboard.
Insurance Specialist/Collections Specialist - Jan. 2003 - Feb. 2006
MetroHealth Medical Center, Cleveland, OH
Serve as a departmental liaison to other hospital administrative units and to sp
ecific payors as appropriate. Monitor and resolve claims on edit hold reports. I
dentify problem payors and associated reasons for slow pay, no pay situations on
a timely basis. Respond to customer service billing concerns. Monitor the statu
s of unpaid claims including denials and appeals using work queues and conductin
g routine follow-up on previously researched claim items. Meeting cash collectio
n goals by reviewing, analyzing, completing, and submitting appropriate forms fo
r pre or post billing. Establish payment terms, negotiate settlements, and scree
n for patient eligibility for charity discounts or referrals. ACD call managemen
t and follow-up. Experience with SMS/HBO, Epic (Resolute, Tapestry and EpicCare)
, RASW, OnBase, and Quadax.
EpicCare), RASW, OnBase, and Quadax.
Account Rep I/II - Jan. 2000 - Nov. 2002
Cleveland Clinic Foundation, Cleveland, OH
Answer employee inquiries regarding health benefits and eligibility. Review and
edit accounts for third-party rebilling, adjustment postings, collection agency
referral, or other options to resolve account balance. Establish payment terms,
negotiate settlements, and screen for eligibility for charity assistance. Resear
ch and process accounts according to Bankruptcy regulations. ACD call management
and follow-up. Experience with RIMS, TOPPS, HBO, and Epic.
EDUCATION
Bachelor of Arts, Organizational Management - Dec. 2010
Malone University, Canton, OH
A.A., Business Management - Nov. 2007
Indiana Wesleyan, Marion, IN
PROFESSIONAL AFFILIATIONS *
Member - Sep. 2008 - Present
Health Care Financial Management, HFMA), Ohio
Certified Patient Account Technician - Aug. 2009 - Present
CPAT, AAHAM, Ohio