Karen E. Rourke
Riverview,FL
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Extensive knowledge of medical insurance, claims, benefits and authorizations. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
23
23
years of professional experience
Work History
R Representative
Orthopaedic Medical Group of Tampa Bay
08.2020 - Current
- ERA Payment Posting for all Insurance receivables.
- Medicare, Medicare Advantage Plans, Medicaid, Commercial and WC Insurance claim follow up.
- Working knowledge of federal and state insurance guidelines required for accuracy with approximately 95% success
- Creating and filing appeals, submitting corrected claims along with correcting claims via SPOT & CGS.
- Confirming eligibility, review and submitted medical records, reviewing EOB’s, confirming accuracy of payment posting, submitting claims to secondary payers.
Real Estate Sales Agent
Neumann Real Estate, William Pitt Sotheby’s International
02.2011 - 05.2020
- Communicated with clients to understand property needs and preferences.
- Negotiated between buyers and sellers of properties with efficiency and transparency to maximize profits and maintain satisfaction of clients.
- Wrote listings detailing and professionally highlighting property features to increase sales chances.
- Educated clients on sales and buying processes and advised buyers on making decisions.
Project Manager Coordinator
Servpro of
07.2015 - 11.2019
- Homeowner’s insurance claim management, scheduling, billing and claim submission.
- Working knowledge of homeowners insurance policies claim submission with 100% accuracy required for payment.
- Assisting assigned Project Manager with all aspects of individual home remediation and re-construction jobs including scheduling, insurance loss approval and claim submission.
- Maintaining and managing requirements as outlined by various insurance companies for each individual home insurance claim. Insurance requirements and parameters differed for each job.
Billing Representative
Constellation Home Health Care
11.2011 - 07.2015
- PPS Home Health & Hospice clean claim submittal, follow up appeals to Medicare, Medicaid, BCBS, Aetna, Cigna, Humana.
- Established & maintained new Hospice billing division within billing dept including Hospice NOE & Revocation submissions with 100% accuracy for claim NOE and claim submissions to Medicare.
- 500,000 monthly clean claim submissions to Medicare
- Worked closely with Intake department reviewing insurance status and potential conflicts with other home care & hospice providers for all new patients.
Keller Williams Realty
06.2006 - 02.2011
- Communicated with clients to understand property needs and preferences.
- Negotiated between buyers and sellers of properties with efficiency and transparency to maximize profits and maintain satisfaction of clients.
- Wrote listings detailing and professionally highlighting property features to increase sales chances.
- Educated clients on sales and buying processes and advised buyers on making decisions.
Senior Billing Coordinator
Tender Loving Care Home Health Care
07.2000 - 06.2006
- PPS Home Care claim submissions to Medicare
- Clean claim submission commercial insurance and Medicaid
- Working knowledge of federal, state and corporate guidelines required for accuracy with approximately 95% success of initial submissions
- Maintained current episodic Medicare billing while reduced outstanding account receivables by 60%
- Researched and resolved outstanding T19 account receivables of 1.8 million dollars, collecting, as part of a team effort, 12+ million dollars
- Provided area business manager with regular reports on status of accounts
- Intake specialist - Confirmed health insurance eligibility for all potential patients
- Cross trained in Oasis/DRG data entry, Payroll Management and Home Care Scheduling
- Floated out to multiple offices on as needed basis.
Education
High School Diploma -
Norwalk High School
Norwalk, CTSkills
- Proficient with ECW, Waystar/Zirmed, CMS/FFS Medicare (SPOT AND CGS) and Medicare HIQA/HIQH
- Availity, Navinet, CT and FL Medicaid, UHC & Wellcare Portals
- Proficient with Microsoft Word, Excel, Power Point, Outlook, Provider Flow, Empower, Microsoft Teams
- ICD-10 and CPT Coding
- Medical Claims Dispute Resolution
- Medical Benefits
- Medical Terminology
- Health Insurance Terminology
- Physician/Surgical Billing and claims
- Homecare Billing and claims
- Hospice billing and claims
- Hospice NOE submissions
Timeline
R Representative
Orthopaedic Medical Group of Tampa Bay
08.2020 - Current
Project Manager Coordinator
Servpro of
07.2015 - 11.2019
Billing Representative
Constellation Home Health Care
11.2011 - 07.2015
Real Estate Sales Agent
Neumann Real Estate, William Pitt Sotheby’s International
02.2011 - 05.2020
Keller Williams Realty
06.2006 - 02.2011
Senior Billing Coordinator
Tender Loving Care Home Health Care
07.2000 - 06.2006
High School Diploma -
Norwalk High School
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