Jennifer M. Ostermann
Government Claims Team Lead
Loyal,WI
Summary
Team Leader experienced in directing activities and promoting a great team atmosphere. Developing strategies, providing training essentials, setting goals and obtaining team feedback. Excellent interpersonal and communication skills. Big picture focused with excellence in communicating goals and vision to succeed. Always striving to be better and embracing change for great business and team success.
Overview
18
18
years of professional experience
Work History
Team Lead- Govt. Claims
Security Health Plan
02.2019 - Current
- Coached team members in techniques necessary to complete job tasks.
- Ran various spreadsheets and inventory for weekly work flow.
- Made changed to Editing documentation for ease in processing as well as Departmental procedures
- Assisted with new team members by relaying information on claims procedures where to locate instruments needed to perform job duties.
- Established open and professional relationships with team members as well as providers to achieve quick resolutions for various issues.
- Handled troubleshooting tasks and used repair methods to rectify claim issues.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Participated in cross-functional team-building activities.
- Researched and voted on Medical Appeals
Health Insurance Claim Reviewer ( SAS)
Security Health Plan
10.2016 - 02.2019
- Processed members incoming Medical claims and Paid or denied medical claims based upon established claims processing criteria.
- Answered incoming calls from Providers on claim status and explained payment /denial in detail.
- Contacted other insurance companies to discuss Coordination and guarantee proper reimbursement of benefits and patients financial responsibilities.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Scanned, received and sent faxes to providers having to do with members claims
- Assisted in sorting incoming mail for SAS Claims as well as mailing ID cards.
- Assisted with training and integration of SAS from LuminX program to Qnxt for claims processing.
Coordination of Benefits Analyst
Security Health Plan
11.2015 - 10.2016
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits.
- Contacted insurance companies to discuss and resolve unpaid claims and incorrectly paid claims due to eligibility chanes.
- Reprocessed claims impacted by other Health insurance denials and re- enrollments.
- Performed analysis to obtain information required to make appropriate health insurance product coordination recommendations.
- Entered and took detailed accident and Workers compensation related claims information for other departments.
- Proven ability to develop and implement creative solutions to complex problems
Neurology Appointment Coordinator
Marshfield Clinic
01.2014 - 12.2015
- Scheduled appointments for customers in person or over telephone.
- Assessed customer needs and responded to customer emails and calls.
- Greeted customers upon arrival and provided appropriate forms to fill out.
- Directed telephone calls to appropriate parties.
- Called and rescheduled appointments for clients.
- Assisted internal staff with clerical and administrative needs to maximize efficiency and team productivity.
- Scheduled/ rescheduled and confirmed all appointments and personal time for 2 separate neurologists
Medicare/Medicaid DME Claims Specialist
Reliant Rehab/Numotion
01.2008 - 11.2014
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Attended Government DME billing workshops
- Managed large volume of medical claims on daily basis.
- Responded to correspondence from insurance companies.
- Used administrative guidelines as resource or to answer questions when submitting medical claims.
- Scheduled maintenance for existing members equipment.
- Trained all newly hired staff.
- Participated in team projects, demonstrating the ability to work collaboratively and effectively
- Demonstrated leadership skills in managing projects from concept to completion
- Proven ability to develop and implement creative solutions to complex problems
Claims Processor
Marshfield Clinic
05.2006 - 01.2008
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Responded to correspondence from insurance companies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Reviewed provider coding information to report services and verify correctness.
- Evaluated accuracy and quality of data entered into agency management system
Education
CPT Coding & ICD 9/ICD 10 -
12.2016
Medical Terminology -
04.2016
HIPPA Govt Accreditation Standards -
05.2012
Accounting And Business Management
01.2009
Highschool Graduate -
06.2000
Skills
- Excellent social and communication skills
- 14 years medical insurance experience with Government entity's (processing, billing procedures, precertification, denials and appeals)
- Knowledge of Excel / Microsoft products
- Health team Leadership and team building
- Attention to Detail
- Ability to learn from past experiences and constructive criticism
- History of superior customer service focusing on establishing great level of comfort with clientele and promoting repeat business
Hobbies
Most of my free time I spend going to My boys Sporting events, crafting, sewing, painting, and constantly redecorating within my house. I love cooking and I also love to get outside when the weather permits and enjoy nature.
Timeline
Team Lead- Govt. Claims - Security Health Plan
02.2019 - Current
Health Insurance Claim Reviewer ( SAS) - Security Health Plan
10.2016 - 02.2019
Coordination of Benefits Analyst - Security Health Plan
11.2015 - 10.2016
Neurology Appointment Coordinator - Marshfield Clinic
01.2014 - 12.2015
Medicare/Medicaid DME Claims Specialist - Reliant Rehab/Numotion
01.2008 - 11.2014
Claims Processor - Marshfield Clinic
05.2006 - 01.2008
Certificate of Completion - CPT Coding & ICD 9/ICD 10,
Certificate of Completion - Medical Terminology,
Quarterly Medicare Training 2009-2012 - HIPPA Govt Accreditation Standards ,
University of WI -Wood County - , Accounting And Business Management
Mosinee High School - Highschool Graduate,
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