Althea Moore
Hoover,AL
Summary
I have 14 years of healthcare experience. Detail oriented with a focus on healthcare management. Successful complete complicated assignments. Highly experienced in insurance HMO and PPO issues and resolving account disputes. Proficient in mandated laws, merging of systems and a variety of practice management software applications. Dedicated to maintaining strict patient confidentiality.
Overview
32
32
years of professional experience
Work History
Underwriting/Commission Analyst
Alabama Self-Insured Worker's Compensation Fund
03.2019 - Current
- Responsible for updating accounts at renewal
- Analyze submissions for eligibility
- Review loss run history & calculate loss ratio
- Develop relationships with agents to help grow book of business
- Manage accounts for commission payment/contribution
- Review reports to confirm completeness and accuracy of commissions and report needed changes to RiskConnect prior to running the commission pay processes
- Process agency commissions, including statements and payment by both check and ACH
- Provide statements as evidence of negative (return) commission and correspond with the agencies for collection
- Follow-up
Office Management/Human Resources Manager
Birmingham Suzuki
Birmingham, AL
06.2006 - 09.2010
- Primary responsibilities for payroll, taxes, time and attendance, benefits, insurance and security of network system
- Ability to lead team with problems
- Projects and other issues with the company
- Provide information or assistance to resolving problems
- Drive staffing process including sourcing strategies, interviewing, job offers and orientation
- Problem solving, determines accuracy and relevance of information
- Used sound judgement to create and make decision with company policies
- Ability to maintain highly sensitive and/or confidential information
- Knowledge of federal, state and local laws and regulations as it relates to benefits (i.e
- ACA, FMLA, Worker’s Compensation, ADA, HIPAA, and COBRA)
Billing Review Analyst
Brookwood Hospital
02.2004 - 06.2006
- Meet guidelines of performance and turnaround time for each client
- Researching information to solve problems and answer questions posed by members and client and good decision making ability
- Verbal and written communications skills to answer emails and calls from providers and staff regarding assigned accounts
- Skill in maintaining a positive working relationship through comfortable and appropriate interpersonal interaction
- Ability to multi-task and work with little direction; strong prioritization and time management skills
Account Manager
CSC (Computer Sciences Corporation)
05.2001 - 07.2003
- Establish & maintain relationships with healthcare facilities within the territory
- Expand and renew client service agreements
- Resolve client issues in a timely manner and keep management appraised
- Follow up with clients on a regular basis
- Ability to define problems, collect data, establish facts and draw valid conclusions
- Develop a comprehensive understanding of insurance compliance guideline
- Reviewing applications, renewal requests, and endorsements for compliance with underwriting authority and guidelines
Enrollment Coordinator Manager
Viva Healthcare
10.1998 - 02.2001
- Responsible for subscriber eligibility, enrollment, and contract maintenance of our group and individual members
- Provide appropriate training and guidance to benefit administrators, also provide guidance to the customer service department, and continuous support to the sales team, marketing team, customer service team, and underwriting
- Responsible for the technical and analytical support of group and individual eligibility
- Interacting with marketing, legal, underwriting, and actuarial to implement new products and related support
- Responsible for corporate operating objectives that include reducing costs, increasing efficiency and improving quality
Medical Billing Specialist, Cobra/Enrollment Coordinator
Complete Health/United Healthcare Insurance Company
05.1992 - 02.1998
- Review documentation provided by the client and account management including applications and documents
- Strong attention to detail to accurately enter data and research and resolve questions
- Accountable for the accuracy, timeliness, and completeness of the implementation process
- Knowledge of healthcare plan, HMO and PPO, Medicare and Medicaid
- Understand what data is needed to address a business question and how to analyze it and interpret results
- Proficient in the use of computers and programs that specialize in data collection and data management
- Merge Coordinator
- Ensure that appropriate resources have been assigned to the project
- Review project guideline with the team
- Ensure clarity of roles by defining each team member’s deliverable for the project
- Establish and track project milestones and deliverables between functional groups
- Work with stakeholders and functional managers to manage the scope timeline and quality of the deliverables
- Claims Plan Services
- Develop and maintain system service codes and plan rules
- Maintain CPT-4 & 9 codes, Revenue Codes, HCPC’s codes, (ICD-9/ICD-10) codes and all modifiers
- Program of all plan parameters in the system
- Develop and maintain suspend reason codes
- Builds all medical, dental, vision, flex, short term disability, long term disability and billing only plans
Education
University of Phoenix
09.2017
University of Alabama
01.1990
Phillips High School
01.1987
Skills
- ICD-9
- CPT-10
- Medical Terminology
- Claim Entry & Payment Posting
- Records Organization & Management
- Benefits Setup
- Excellent Interpersonal Skills
- Insurance & Patient Aging
- Training & Development
- Excellent Phone Skills
- HIPPA Compliance
- Policy Formulation
- Various Practice Management Software
- Online Claim Submission & ERA
- Labor Law
Technologysummary
- MS Office (Word, Excel, Outlook, Powerpoint)
- AS400/Powerstep/Txen
- ADP Payroll System
- Ventiv/Riskconnect
Timeline
Underwriting/Commission Analyst
Alabama Self-Insured Worker's Compensation Fund
03.2019 - Current
Office Management/Human Resources Manager
Birmingham Suzuki
06.2006 - 09.2010
Billing Review Analyst
Brookwood Hospital
02.2004 - 06.2006
Account Manager
CSC (Computer Sciences Corporation)
05.2001 - 07.2003
Enrollment Coordinator Manager
Viva Healthcare
10.1998 - 02.2001
Medical Billing Specialist, Cobra/Enrollment Coordinator
Complete Health/United Healthcare Insurance Company
05.1992 - 02.1998
University of Phoenix
University of Alabama
Phillips High School
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