Reimbursement Specialist Resume Example
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Manilla Joe 123 Fake Street,Null Cell:123-456-7890 E-Mail: email@example.com Street, CA Professional Summary Healthcare reimbursement coordinator with 8+ years of advancement and achievement. Draw on exemplary customer service and administrative skills to provide efficient, accurate claims management. Confident leader with demonstrated success managing and motivating a 10member team. Foster productive relations with all colleagues and staff members. Augment strengths with commitment to ongoing professional development. Bilingual: Fluent in Polish and English. Highlights Medicaid and Medicare Policies Health Claims Management Prescription Adjudication Inventory Control and Monitoring HIPAA Regulatory Compliance Reimbursement Coordination Staff Training and Development Prior Authorizations Professional Experience Reimbursement Supervisor August 2011 to Current Omnicare City, State Lead a 10-person department managing health claims intake and adjudication. Maintain duties of prior roles. Train and educate staff to efficiently complete all work while adhering to rigorous company standards. Review, research, and audit pharmacy-submitted claims. Manage point-of-sale (POS) claims for multiple pharmacies in New Jersey and Pennsylvania. Complete annual company-mandated certificate training. Maintain up-to-date knowledge of Medicare and NJ Medicaid practices. Work productively with clinical intervention center to gain approvals. Third Party Billing Adjudicator November 2006 to August 2011 Omnicare City, State Quickly resolved and processed prescriptions, communicating effectively with patients, doctors, and facilities. Focused on adjudication of real time third-party pharmacy claims for commercial and Medicare Part D patients.