1234 Fake Lane, MA, 99999, Cell:(000)-000-0000, email@example.com
Claims Operations Specialist with over 20 years of progressive career experience in insurance claims, healthcare, revenue management, and training. Significant training in claims management including workers’ compensation and claims adjusting. A hands-on and innovative professional recognized for exceptional ability to create, implement, and facilitate successful projects including curriculum and development training programs.
Areas of Expertise
Claims Operations: Highly skilled in analysis, review, and adjudication of healthcare and dental claims for processing through payment and denial off-set. Claims Processing: Experienced in processing claims for inpatient, outpatient, facility, and professional services for IPA, HMO, Medicare, Alameda Alliance, Healthy Families, Medi-CA, Self, and 3rd Party. Claims Adjusting: Licensed Insurance Adjuster and Auditor in California. Training: Skillfully integrate knowledge and train other claims examiners on policies, procedures, and protocol. Develop audit and training programs with retention benefits and outcomes for employers and employees. Financial Administration: Proficient in budgeting, accounting, auditing, and report generation in medical billing and insurance claims settings.
Strategic Revenue Financial Operations Director 12/2006 to Current TCS Management Company, LLC Walnut Creek, CA Provide accounting and financial support to small business clients including cash flow, contracts, auditing, billing, collections, and payroll. Process employer-authorized medical claims and verify insurance benefits to ensure that authorizations are obtained in a timely manner. Perform daily audits on accounts and business office representatives to ensure accuracy. Oversee the planning, development, training, and evaluation of an 82-person accounting department. Ensure accuracy of patient registration and intakes for billing purposes. Create marketing presentations and training modules for staff and client base. Program Director 04/2005 to 01/2007 Western Career College, Silicone Valley College Emeryville, CA Developed curriculum for Health Information Technician and Healthcare Administration programs. Awarded Star Teacher and Director Award in 2006 for superior instruction to students and program development. Coordinated career fairs, Technology Week, career interview workshops, and speakers for the HIT program. Audited classrooms to evaluate instructors and ensure that curriculum was properly executed. Monitored and analyzed departmental budget, attendance, retention, and other reports. Prepared and oversaw auditing and accreditation visits. Senior Instructor and Assistant Program Chair 04/2002 to 05/2005 Bryman College Hayward, CA Implemented the medical insurance billing and coding curriculum and developed the Advanced After-Collection and Coding Workshop for graduate medical billing students. Developed an off-site practice management office with a medical provider for in-field experience. Designed the college library and a testing center for medical programs students to prepare and receive certification under the National Center for Competency Testing. Coordinated the Healthcare Professional Career Day and off-site medical facility visits for MIB students. Prepared quarterly campus accounting and budget reports, and assisted registrar with various reports as necessary.