Angela Hayes
Hanover,PA
Summary
Claims and litigation management professional who brings strong investigation, coverage analysis, and reserve-setting skills to complex files. Supports mediations, settlement conferences, and excess reporting while mentoring new hires and serving as a liaison for medical billing issues and workflow questions.
Overview
27
27
years of professional experience
Work History
Senior Claims Handler
PMAMC Companies/Lodestar Claims & Risk Serives
Blue Bell, PA
04.2015 - Current
- Handled high volume of catastrophe and large loss claims across multiple jurisdictions including DC, MD, and NJ.
- Investigated assigned claims to confirm coverage, jurisdiction, and third-party responsibility, made timely contacts with insured, claimant, medical provider, and witnesses, set reserves for medical treatment, litigation costs, and loss time/permanency costs, and documented files with appropriate action plans.
- Proven success in handling full investigation of large volume of COVID exposure claims during the pandemic. Making appropriate compensability decisions according to state presumption laws, closing 95% without litigation occurring. Remaining 5% was able to work with assigned defense counsel and insured to minimize future cost exposure
- Knowledge of medical terminology and medical treatment, which allows for proficiently reviewing requests for medical treatment, authorizing what is deemed causally related to work injury and when assignment of nurse case management is needed. All while using contracted vendors whenever possible to reduce the cost of the claim.
- Experienced in working with multiple defense law firms, actively participating in an action plan to minimize the cost exposure. Attending mediations, settlement conferences, and court hearing when necessary. Obtaining MSA from contracted vendors, obtaining necessary approval from CMS, and negotiating structured MSA, to reduce cost of MSA and to avoid future cost exposure and reopening of file for worsening.
- Presented investigation findings and suggested action plans during round table discussions with upper management and quality assurance.
- Applied knowledge of excess reporting for accurate claim assessments.
- Mentor new hires, Designated Conduent (medical billing software) liaison to filter and resolve coworker's problems or concerns.
- Assigned new claims to team members when supervisor was not in the office and assisted with any questions or problems that may arose.
Medical Billing/Orthopedic Coder
Well Span Health
York, PA
02.2013 - 04.2015
- Reviewed clinical documentation to assign precise diagnosis and procedure codes, enhancing coding accuracy and reducing claim rejections.
- Coded patient encounters for WellSpan Health using ICD-10-CM, CPT, and HCPCS, ensuring compliance and accuracy in billing.
- Resolved coding edits through Epic and billing system workflows, facilitating timely claims processing and minimizing billing discrepancies.
- Queried providers for missing documentation to support compliant code assignment.
Office Manager/ Medical Billing Orthopedic Coder
Greater Chesapeake Orthopedic Associates, LLC
Baltimore, Maryland
02.2000 - 02.2013
- Manage insurance verification, referrals, and prior authorization workflows.
- Support billing, collections, and patient account follow-up for orthopedic services.
- Coordinate patient scheduling, registration, and appointment reminders across clinical departments.
- Supervise medical office staff, assign duties, and support hiring and onboarding.
- Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
- Maintained optimal supply levels for office operations and placed new supply orders.
- Resolved customer inquiries in a timely manner while maintaining positive relationships with clients.
Education
Associate of Arts - Business Administration
Catonsville Community College
Catonsville, MD05-1997
Skills
- Claims expertise
- Litigation management
- Claim negotiation tactics
- Claims training programs
- MS office
- Workflow management
- Time management
- Deadline adherence
- Task prioritization
- Leadership experience
- Effective communication
- Clear communication
Timeline
Senior Claims Handler
PMAMC Companies/Lodestar Claims & Risk Serives
04.2015 - Current
Medical Billing/Orthopedic Coder
Well Span Health
02.2013 - 04.2015
Office Manager/ Medical Billing Orthopedic Coder
Greater Chesapeake Orthopedic Associates, LLC
02.2000 - 02.2013
Associate of Arts - Business Administration
Catonsville Community College