Kolleen Ledterman
Springboro,OH
Summary
Always interested in expanding my knowledge. Currently working as a
Case Management Assistant II. Interested in moving forward into the Case Management Assistant III position.
Overview
30
30
years of professional experience
Work History
Case Management Assistant II
Sutter Healthcare
02.2010 - Current
- Review, correct, and document payments, contract accuracy, and assist with education of Claims Staff.
- Medical Directors, Nurses and all Claims employees processing our downstream claims.
- Currently I am working directly with UM staff, doctors and claims staff with incoming CRM's.
- Answer Peer to Peer calls for the MD's.
- Keeping accurate records, getting messages to the Doctors in a timely manner and follow up and work with referrals that are overturned.
- Complied reports for Medical Directors and Management. Used for education of employees.
Medical Claims Supervisor
Palo Alto Medical Foundation, PAMF
02.2008 - 02.2010
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Supervised 6-7 Employees
- Researched and resolved complex medical claims issues to support timely processing.
- Assisted with the Annual Audits, pulling claims, making copies, sitting with the auditors answer questions and follow up with Action Plans.
- Identified and resolved discrepancies between patient information and claims data.
- Responded to correspondence from insurance companies
- Processed insurance payments and maintained accurate documentation of payments
Claims Payor
Santa Cruz Medical Foundation
11.1997 - 02.2008
- Examine claims for errors, payment discrepancies, contract set up and verify authorizations.
- Used CCI Edits to assist in processing the claims. entered Paper claims into the IDX and HMO systems.
- Worked closely with the Medical Directors and Nurses to assure authorizations are on file and are correct.
- Work closely members, providers and MD's to ensure compliance and accuracy.
- Complied reports for MD's and Management.
- Entered paper claims into IDX.
- Established relationships with clients and insurance companies to foster timely claims resolution.
- Examined claims forms and other records to determine insurance coverage
- Researched and analyzed policy contracts to verify proper payment of claims
Patient Accounting Representative
Santa Cruz Medical Clinic
02.1994 - 11.1997
- Used data entry skills to accurately document and input statements.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Assisted with the Filing of Medical Charts.
- Complied the doctors schedules in IDX.
- Made appointments for the MD's in Aptos.
- Responded to customer concerns and questions on daily basis
- Collaborated with customers to resolve disputes.
Education
Associate of Arts - Business Administration And Management
Ohlone Junior College
Fremont06.1986
Timeline
Case Management Assistant II
Sutter Healthcare
02.2010 - Current
Medical Claims Supervisor
Palo Alto Medical Foundation, PAMF
02.2008 - 02.2010
Claims Payor
Santa Cruz Medical Foundation
11.1997 - 02.2008
Patient Accounting Representative
Santa Cruz Medical Clinic
02.1994 - 11.1997
Associate of Arts - Business Administration And Management
Ohlone Junior College
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