Senior Recovery / Resolutions Representative Resume Samples
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Senior Recovery / Resolutions Representative Resume Samples
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LL
L Labadie
Lenora
Labadie
769 Kunze Vista
New York
NY
+1 (555) 390 5602
769 Kunze Vista
New York
NY
Phone
p
+1 (555) 390 5602
Experience
Experience
Philadelphia, PA
Senior Recovery Resolutions Representative
Philadelphia, PA
Nader-Labadie
Philadelphia, PA
Senior Recovery Resolutions Representative
- Acts as a resource for others
- Provides claims support to our COB (Coordination of Benefits Group) by reviewing, researching, investigating, negotiating and resolving all types of claims related to incorrect or overpayments
- Performs additional research verifying the member status, eligibility and coverage according to the specific contract to identify any issues/accuracy or the possibility of any third party responsibility
- Perform other duties as assigned
- Coordinates others' activities
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Works independently
Los Angeles, CA
Senior Recovery / Resolutions Representative
Los Angeles, CA
Lindgren-McGlynn
Los Angeles, CA
Senior Recovery / Resolutions Representative
- Fundamental Execution: plan, prioritize, organize and complete work to meet established production goals, quotas and deadlines in a fast pace and ever changing environment
- Communicate via phone, letters or e-mails, overpayment information to payers/providers or members, including explanations of the reason for the overpayments
- May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data
- Generally work is self-directed and not prescribed
- Provide claims expertise support by reviewing, researching, investigating, negotiating, and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Analyze, identify trends, and provide reports as necessary
- Manage subrogation files
present
Dallas, TX
Senior Recovery / Resolutions Representative
Dallas, TX
Abbott, Collier and Graham
present
Dallas, TX
Senior Recovery / Resolutions Representative
present
- Makes fact- based decisions; uses sound judgment and applies business knowledge
- Performs basic and specialty workflow and administrative tasks with minimal supervision
- Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, and attendance
- Work independently with little direct onsite supervision
- Provide expertise by reviewing, researching, and resolving all types of accounts in a credit balance to bring final resolution and root cause analysis for health plans, commercial customers and government entities
- Fundamental Execution: Plan, prioritize, organize and complete work to meet established production goals, quotas and deadlines in a fast pace and ever changing environment
- Analyze and identify trends and provide reporting as necessary
Education
Education
California State University, Fullerton
Skills
Skills
- Basic proficiency in math and thinking analytically and strategically
- Strong ability to multi-task and work independently
- Ability to work in a production environment and meet / exceed productivity, quality and timeliness goals
- Ability to work in a production environment and meet/exceed productivity, quality and timeliness goals
- Basic proficiency in standard math (addition, subtraction, multiplication, division)
- Ability to work in a dynamic environment both independently and in a group setting
- Excellent written, analytical and verbal communications skills
- Strong direct and indirect communication skills
- Team player; works effectively with others. Ability to work independently and exercise sound judgment
- Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
1 Senior Recovery / Resolutions Representative resume templates
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1
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Communicate and/or meet with the provider appropriately to ensure Optum is meeting the needs and expectations of the provider and build a good rapport with the provider contacts by establishing professional working relationships to ensure operational efficiency
- Ability to travel, 2 week training program held in Tennessee and then up to 25% of the time (generally local to MN, but some overnight)
- Basic proficiency in math and thinking analytically and strategically
- Experience with PC and Windows including dual monitors, web based applications, working with multiple systems
- Experience with Excel (i.e. sorting, summing, creating bar graphs, formulas)
- 2+ years of experience in revenue cycle environment
- Healthcare finance experience with a focus in auditing and/or analysis
- 2+ years of Account Management or Customer Service experience
- Strong Communication and Customer Service skills
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Senior Recovery / Resolutions Representative Resume Examples & Samples
- 2+ years experience with PC and Windows (ability to know basic computer functions, print, organizing and finding files)
- 1+ year of experience with Excel (i.e. sorting, summing, creating bar graphs, formulas)
- Ability to travel, 2 week training program held in Franklin, Tennessee and then up to 25% of the time (generally local, but some overnight)
- 1+ year of work experience in a position where basic math was utilized and preformed correctly
- Associate's or Bachelor's Degree (or higher) in a Business field
- Healthcare Finance experience with a focus in auditing and/or analysis
- Proficiency in thinking analytically and strategically
- Basic proficiency in standard math (addition, subtraction, multiplication, division)
3
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Develops and expands knowledge of COB Rules, basic Computer skills and business etiquette
- Performs basic and specialty workflow and administrative tasks with minimal supervision
- Collaborates with others to identify and solve moderate problems and create procedures that promote efficiency and quality
- Initiates telephone calls to members, providers and other insurance companies to gather COB data
- Receives and respond to incoming telephone inquiries
- Determines primacy using published COB
- Updates eligibility system/ database with outcome of primacy investigation
- Documents and communicates outcome of investigation following departmental procedures
- Meets productivity, quality and timeliness goals
- Responds to routine or standard requests to meet customer needs
- Focuses on Customer; exceeds expectations and improves customer experience
- Makes fact- based decisions; uses sound judgment and applies business knowledge
- Acts ethically; demonstrates integrity, complies with all laws, regulations and policies
- 1+ years of experience working with MS Word (document creation), MS Excel (basic spreadsheet, sorting, and data entry), MS PowerPoint (basic presentation creation), MS Outlook (sending emails)
- Any experience with US Healthcare and/or COB experience
- Excellent written, analytical and verbal communications skills
- Ability to work in a production environment and meet/exceed productivity, quality and timeliness goals
- Team player; works effectively with others. Ability to work independently and exercise sound judgment
4
Senior Recovery / Resolutions Representative Resume Examples & Samples
- 1+ year of experience in a role using basic math and thinking analytically and strategically
- 2+ years of experience with PCs and Windows Applications with the ability to learn new and complex systems
- 2+ years of experience with intermediate level of proficiency with Excel (i.e. sorting, summing, creating bar graphs, and formulas)
- Working Hours - 40- hours standard, OT if business needs dictate but not regular
- Bachelor’s Degree or Higher
- Previous experience working in a Client Facing Role and/or working onsite at a client site
- 3+ years of experience in Claims Recovery and Resolution or an Operations Based environment
5
Senior Recovery / Resolutions Representative Resume Examples & Samples
- 1+ years of experience in an office or operations based environment
- 1+ years of experience with Microsoft Excel (sorting, summing, creating bar graphs, and formulas)
- Ability to travel to a 2 week training program held in Tennessee and then potentially up to 50% of the time (generally local)
- 1+ years of experience working in Claims Recovery and Resolution
6
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Recovery through Technology
- Review Process and Analyze Data
- Follow up with Provider and Payers
- Work equally well in team and independent environment
- 2+ years of customer service experience (i.e. analyzing and solving customer problems)
- Intermediate level of proficiency with Microsoft Word and Excel (Word – creating and editing Word documents; Excel – creating and editing spreadsheets, sorting/filtering)
- Ability to train in TN for 2-3 days upon starting
- Bachelor's Degree (or higher)
- 1+ year of experience in healthcare and or insurance fields (i.e. someone who can read an EOB, etc.)
- Previous experience within an auditing, accounting and or analytical role
- Able to take initiative on tasks to get them completed on time
7
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Analyze, identify trends, and provide reports as necessary
- 1+ years of claims or collections experience within the healthcare industry
- 1+ year of customer service experience analyzing and solving customer problems
- 1+ years of experience working with computers and Windows PC applications
8
Senior Recovery / Resolutions Representative Resume Examples & Samples
- May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data
- Investigate and pursue recoveries and payables on subrogation claims and file management
- May conduct contestable investigations to review medical history. May monitor large claims including transplant cases
- 1+ years of customer service experience analyzing and solving customer problems in a Call Center (healthcare or other), Claims environment or other closely related field
- Ability to create, edit, save, and send documents utilizing Microsoft Word and Excel
- 2+ years of claims or collections experience
- Experience working with subrogation
- Strong Verbal and Written Communication skills
- Ability to work in an environment that has changing processes on a regular basis
9
Senior Recovery Resolutions Representative Resume Examples & Samples
- Performs additional research verifying the member status, eligibility and coverage according to the specific contract to identify any issues/accuracy or the possibility of any third party responsibility
- Completes on a daily basis all data entry required to document and communicate the status of claims as needed adhering to all reporting requirements
- Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, and attendance
- 1+ year Customer Service Representative (CSR) or Claims Representative experience or 1+ year experience in an office setting, call center setting or phone support role
- Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
10
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Knowledgeable with all controllable and non-controllable flag types and associated platforms
- Placement, modifications and removals of all controllable and non-controllable flag types
- Communication with claims platform personnel for flag placement
- First point of contact for projects requests
- Contributes to support P&P and Job Aids
- Daily Team communication
- Lead small projects
- Support escalations from leaders
- Testing and implementation support
- 1+ years of Healthcare experience
- Proficiency with Microsoft Excel (including data entry and editing data/formatting within existing spreadsheet)
- Quality Assurance knowledge
- 3+ months of related flagging experience
- Proficiency and knowledge in working all flag types and associated platforms
- Ability to facilitate meeting
- Ability to adjust to changing priorities
- Self-directed
- Strong Process and analytical thinking skills
- Strong organizational Skills
- Strong ability to multi-task and work independently
- Ability to adapt to constant change
- Proven ability to successfully work with cross-functional teams and clients
11
Senior Recovery / Resolutions Representative Resume Examples & Samples
- High School Diploma/GED OR 10+ years of customer service experience analyzing and solving customer problems
- 2+ years of Healthcare claims or collections experience
- 1+ year of experience working with computers and Windows PC applications; maneuvering through multiple windows and typing
- 1+ year of ODAR experience
- 1+ year of IDARs experience
- Beginner experience with Microsoft Excel; general data manipulation
12
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Verify other insurance coverage through automated phone lines, databases, outreach to commercial payers, and other available methods
- Data entry of other insurance coverage findings into internal applications
- Initiate phone calls to employer groups, and other insurance companies to gather pertinent claim information, confirmation of services received and coordination of benefits information
- Work directly with other departments to enhance and refine assigned inventory to maximize value
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Serves as a resource to others
13
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Intermediate proficiency with PC and Windows
- Intermediate level of proficiency with Microsoft Excel (i.e. sorting, summing, creating bar graphs, formulas)
- Available to work 40 hours per week and overtime if business needs dictate
- Ability to travel to 2 week training program held in Tennessee and then up to 25% of the time (generally local, but some overnight)
14
Senior Recovery / Resolutions Representative Resume Examples & Samples
- 2+ years of experience with intermediate level of proficiency with Microsoft Excel (i.e. sorting, summing, creating bar graphs, and formulas)
- Ability to work overtime if business needs dictate but not regular
- 3+ years of experience in Claims Recovery and Resolution or an Operations based environment
15
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Provides claims support to our COB (Coordination of Benefits Group) by reviewing, researching, investigating, negotiating and resolving all types of claims related to incorrect or overpayments
- Communicate via phone, letters or e-mails, overpayment information to payers/providers or members, including explanations of the reason for the overpayments
- Negotiates with applicable parties (other insurance carriers, members, providers or attorneys) the claim recovery amounts required, secures payment and ensures the crediting of the amount to the correct claim/overpayment
- Prior knowledge of claims processing procedures, systems and contract, privacy and government regulations preferred
- 1+ year experience working with Windows based PC applications including the ability to learn new and complex computer system applications
16
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Communicate and / or meet with the provider appropriately to ensure Optum is meeting the needs and expectations of the provider and build a good rapport with the provider contacts by establishing professional working relationships to ensure operational efficiency
- Experience with Microsoft Excel (sorting, summing, creating bar graphs, formulas)
- Ability to travel up to 25% of the time (Mandatory 2 week training in Franklin, TN (near Nashville, TN) + 1 week virtual training (from home) + 2 week onsite training)
- 3+ years of experience in Claims Recovery and Resolution or in an operations based environment
- Healthcare Finance experience with a focus in auditing and / or analysis
17
Senior Recovery / Resolutions Representative Resume Examples & Samples
- 1+ years of customer service experience analyzing and solving customer problems
- Ability to work an 8 hour shift between 6:00 am and 6:00 pm Monday through Friday
- 1+ years of working experience with processing C&S, M&R, or E&I refunds
- 1+ years of experience using claims platforms such as UNET, COSMOS, NICE, Facets, Diamond, etc
- Experience working with LBWS and ODAR
- Experience with UHG platforms and computer systems
- Experience working with Microsoft Word (document creation), Microsoft Excel (data entry), and Microsoft Outlook (sending emails)
18
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits information
- C / D Analyst Job Description
- Adjudicate claims, review provider contracts, and evaluate payment policies to ensure claim payment accuracy
- May conduct contestable investigations to review medical history
- May monitor large claims including transplant cases
- Meet Quality and Productivity requirements
- Undergraduate Degree (or higher) or High School Diploma / GED with 2+ years of experience in collections, claims, or customer service
- 2+ years of experience with claims auditing and researching claims information
- 1+ years of experience analyzing data and identify cost saving opportunities
- Experience working with medical claims platforms
- Knowledge of claims processing systems and guidelines / processes
- Experience in healthcare
- 1+ years of project management experience
- Knowledge of Medicaid / Medicare Reimbursement methodologies
19
Senior Recovery / Resolutions Representative Resume Examples & Samples
- 1+ years of experience in role using math and thinking analytically and strategically
- 2+ years of experience with intermediate level of proficiency with Microsoft Excel (i.e. data entry, sorting, and filtering)
- Ability to work between the hours of 6AM-5PM, CST 8 hours per day for a 40 hour work week
- Ability to work overtime if business needs dictate but not regularly
- Ability to travel for a 2 week training program and then up to 75% of the time (generally local, but some overnight) required
20
Senior Recovery Resolutions Representative Resume Examples & Samples
- Manage subrogation files
- 1+ years of Healthcare experience (i.e. working in an insurance setting, in a provider’s office, billing office, doctor’s office, etc.)
- 1+ years of Customer Service experience (i.e. analyzing and solving customer problems)
- Beginner proficiency with Microsoft Excel using the sort and filter functions
- Ability to work 8 hour shift between the hours of 7:00 am to 7:00 pm Monday through Friday
- 1+ years of experience in a Collector role
- Experience in medical claims and / or adjustments
- Customer service experience in a Healthcare and / or Call Center environment
- Experience in medical insurance (i.e. dealing with insurance from a billing and / or health plan standpoint)
21
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Communicate professionally with the provider to ensure PRS is meeting the needs and expectations of the client; build a good rapport with the provider contacts by establishing professional working relationships to ensure timely recoveries
- Analyze, identify trends, and provide inventory and or client updates as necessary
- Must meet state and federal compliance policies, reimbursement policies, and contract compliance
22
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Intermediate level of proficiency with Microsoft Excel required (i.e. sorting, summing, creating bar graphs, and formulas)
- Working Hours - business hours - 40 hours standard, overtime if business needs dictate but not regular
- Ability to travel, up to 25% of the time (generally local, but some overnight) required
- Basic proficiency in math and the ability to think analytically and strategically
23
Senior Recovery / Resolutions Representative Resume Examples & Samples
- Fundamental Execution: plan, prioritize, organize and complete work to meet established production goals, quotas and deadlines in a fast pace and ever changing environment
- Intermediate proficiency or higher with PC and Windows (ability to navigate between computer programs and screens)
- Intermediate proficiency or higher with Microsoft Excel required (i.e. sorting, summing, creating bar graphs, and formulas)
- 2+ years of experience in claims recovery and resolution or in an operations based environment
