Account Specialist Resumes in US-Ohio-Akron: Karen

Account Specialist Resume

Contact Candidate

Name:

Karen

Location:

US-Ohio-Akron

Experience:

1-3 yrs

Willing to Relocate:

Willing to Travel:

Most Recent Job Title:

Account Specialist

Personal Website:

kbrugmann@neo.rr.com

Objective:

Challenging position that utilizes experience and knowledge base.

Resume Text:

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ces for people with developmental disabilities, behavioral health needs, and other related conditions. Services are provided throughout the life span (from birth through adulthood). Also responsible for billing contracts, school districts, private patients, private insurances, HELP ME GROW program through Akron Children’s Hospital, and agencies including, but not limited to, National Alliance for the Mentally Ill (NAMI), County of Summit Board of Mental Retardation/Developmental Disabilities (CSBMR/DD), Ohio Department of Mental Retardation/Developmental Disabilities (ODMR/DD), Summit County Alcohol, Drug Addiction, Mental Health Services Board (ADM Board), Ohio Department of Mental Health (ODMH), and Ohio Provider Resource Association (OPRA). In addition, this job description includes posting payments received from payers, entering contract data into XAKT system, tracking daily deposits on excel worksheets, reconciling variances in payments, working aging reports (unpaid billings), developing and maintaining reports for accounts payable and receivable, credentialing providers affiliated with the clinic, working with all providers in the clinic with all coding and service details (M.D., PhD, OT, PT, ST, Social Workers, and school teachers), and maintaining deadlines crucial to monthly, quarterly, and yearly accounting reports. Aetna, Inc., Richfield, OH – 2003 to 2007 Patient Management, Care Management Associate Responsible for obtaining and entering demographics for inpatient confinements and some outpatient procedures in compliance with the precertification process for the Dedicated Area. - Completed orientation and training on Aetna policies, procedures, and core principles, including, but not limited to, refresher training on Rumba (CCI, EPDB, Healthline, Autocoder), eService, Microsoft Outlook, TOLR, Navigator; along with new training on Patient Management and the eTums System. - Learned product features and benefits and applied them correctly as evidenced by documentation of proper service authorizations specific to the members plan. - Attended the following Education Seminars, which enhanced current medical knowledge: New Generation Antibiotics, Synagis-RSV, Acute Coronary Syndrome, Antibodies for Non Hodgekins Lymphoma, Osteoporosis, Cystic Fibrosis, and Renal Disease. - Handle incoming and outgoing phone calls with providers, members, and plan sponsors, utilizing the precertification process and managing trouble-shooting and plan specific questions. - Coordinated educational and celebratory events for National Customer Service Week during the week of October 2-6, 2006, for the Richfield Dedicated Unit. - Chosen in December, 2006, to coordinate Maps Training for the entire Richfield Aetna office. Chosen as a preceptor for the Richfield Dedicated Unit. In addition, assisted new employees with hiring and orientation. Responsible for orientation, training, re-training, and tracking audits for performance appraisals and bonuses. Also kept track of attendance, time off, and vacations for our unit. Aetna, Inc., Richfield, OH – 1982 to 2002 Senior Quality Analyst, Credentialing – 1996 to 2002 Responsible for obtaining, verifying. Credentialing, and re-credentialing up to 300,000 health care providers applying to Aetna Networks in three separate regions – utilizing online resources, extensive training in our home office in Connecticut, and documents received and investigated from providers. Assisted with mentoring and precepting new employees. • Composed verbiage to be utilized by entire staff for health care providers’ files enabling unit to remain consistent. • Launched and coordinated morale booster within our unit by setting up monthly cheer fund while consistently exceeding goals. • Assisted in training and developing new data entry processors within our unit while saving time for trainers and supervisors. Also worked with supervisor to determine goals achieved, monitor progress, and access other employees for performance appraisals and bonuses. Member Service – 1994 to 1996 and 1984 to 1993 Responsible for all areas of customer service including phones, letter writing, personal contact with customers, resolving problem issues and various special projects for traditional insurance and HMO. Also, worked in Human Resources – assisting with mentoring, precepting, and new employee orientation. • Handled phone calls, letters, problem issues, and all customer service work for HMO, PPO, Managed Care, and Traditional Choice Indemnity Plans in Akron and Richfield offices. • Developed and logged quarterly reports for specific medical conditions resulting in development of trend reports. Handled extensive spread sheets and presentations for plan sponsor seminars. Assisted supervisor and Human Resource coordinator with payroll, sensitive employee issues, and interviewing potential new employees. • Assisted supervisor with various duties including stop/loss reports, overpayment logs, appeals/complaints on claims/phones, and supervisor backup while continuing to maintain productivity. In addition, handled complaints and appeals for the unit - including, but not limited to, letters, phone calls, internal and external investigation, contacts with plan sponsors and providers, and resolution. Complex Dental Analyst – 1993 to 1994 Identified, reviewed and processed complex dental claims as well as all customer service work for these claims. • Established pilot unit that handled all aspects of dental only claims, producing a central work area. • Assisted supervisor with tracking and reporting to management of all aspects of managing unit leading to consistent workflow. • Assisted dental consultant with interpretation of insurance wording in determination of claims, providing consultant with broader knowledge of insurance terminology. Claims Processor – 1982 to 1984 Responsible for processing and payment of medical and dental claims as well as processing of temporary disability income claims. • Processed claims, maintaining 100% quality, in addition to serving as back-up to customer service. • Trained as temporary disability processor while continuing current service levels. • Assisted supervisor in cross training of new processors, saving time needed for training class operation. Additional Relevant Experience A variety of administrative and office management positions at other companies including A. Schulman, Inc., and Schrader Bellows. These competencies include stenography, expediting domestic and international orders, training employees, and various human resource functions for a plant manager and the union workers. In addition to confidential personnel issues, I worked with payroll for salary and hourly union workers as well as assisting Human Resources with new hires and all relevant paperwork for all new hires. EDUCATION Journalism, Creative Writing and Secretarial courses – 2 years, University of Akron, Akron, Ohio Diploma, John R. Buchtel High School, Akron, Ohio Aetna Training – 16 week course.

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