LAMOND MOORE
North Las Vegas,NV
Summary
Results-driven professional highly experienced in health insurance and collection environments. Natural leader and operational problem-solver successful at overseeing staff, optimizing program operations and cultivating best practices to meet organizational and regulatory expectations. Effective at leveraging interpersonal communication skills to develop long-lasting relationships with internal and external customers. Proficient in management, training, mentoring, coaching, claims, benefits, medical coding and billing, data analysis, accounts receivable, cash receipts and auditing.
Overview
21
21
years of professional experience
Work History
Recovery Resolutions Consultant
Optum, UnitedHealth Group
Las Vegas, NV
10.2022 - Current
- Investigated and solved claims issues, submitted to the CES Recovery sharepoint within and optimal response time.
- Researched CES edits to unsure rules applied to claims accordingly.
- Updated CES rules to align with stakeholders market approved change request.
- Ensured CES rules were updated and functioning accordingly in coordination with AMS Services.
- Provided claims data for CES monthly market rule presentation, via Power BI.
- Developed, implemented and updated, CES Recovery workflow process.
- Coordinated, managed and tracked CES Recovery efforts, through direct collaboration with Care Delivery Operations stakeholders.
- Prepared accurate and concise data reports conveying, CES Recovery progress and results.
- Utilized document management system to organize company files, keeping up-to-date and easily access data to maximize daily task.
Supervisor New Day Claims
Optum, UnitedHealth Group
Secaucus, NJ
10.2021 - 10.2022
- Responsible for providing expertise or general claims support to team in reviewing, researching, investigating, processing and adjusting claims.
- Supervised and coordinated, the daily activities of claim team.
- Created excel reporting, pivot tables and vlookups for trending.
- Set priorities for the team to ensure task completion.
- Coordinated work activities with other supervisors.
- Developed plans to meet long and short-term objectives.
- Identified and resolved operational problems using defined processes, expertise and judgment.
- Collaborated with internal business partners to resolve claims errors/issues (e.g., Subject Matter Experts, Network Management, IT/systems staff, Compliance, vendor management teams, contract teams).
- Documented and communicated status of claims/investigations to stakeholders as needed, adhering to reporting requirements (e.g., status letters/reports).
- Ensured accuracy and compliance with internal and external policies.
Collections Specialist
Accurate Collection Services
Morristown, NJ
03.2016 - 10.2021
- Collected directly from patients or authorized third party payers.
- Followed up on accounts with patient and third party payers to obtain patient demographics and insurance information for billing purposes.
- Followed up with insurance carrier(s) regarding denied claims and submit appeals if necessary.
- Researched and analyzed data, to insure complex issue resolution in a timely manner.
- Determined impact of proposed solutions for delinquent patients, discussed options and determined candidates for settlements.
- Maintained consistent high performance by establishing solid record of achieving or exceeding objectives.
- Maintained Collection Legal Software accounts with appropriate documentation.
- Interpreted and applied cooperate, federal and state policies and regulations accordingly.
Recovery Supervisor II
HORIZON BLUE CROSS BLUE SHIELD
Newark, NJ
01.2005 - 07.2013
- Supervised, coached and mentored a business team of 15 or more employees.
- Created excel reporting, pivot tables and vlookups for trending.
- Reduced account receivables inventory by 15% above service level agreements.
- Recovered 70+ million dollars per year, by ensuring work assignments were done to service level agreements.
- Participated and overseen team related projects.
- Identified inefficiencies in work flows and adjusted business rules accordingly.
- Assisted with preparation and ongoing updates of Sarbanes-Oxley Act narratives.
- Ensured accuracy and compliance with internal and external policies.
- Ensured team achieved call center metrics to service level agreements.
- Partnership with internal and external customers to ensure customer satisfaction.
Technical Support Analyst II
HORIZON BLUE CROSS BLUE SHIELD
Newark, NJ
08.2003 - 12.2004
- Assisted team with complex accounts receivable and cash receipt cases.
- Trend and reported accounts receivable and refund receipts using ms excel pivot tables and vlookups.
- Analyzed work flows and recommended process improvement, which maximized recovery dollars and inventory control.
- Created, coordinate and implemented team training to on board new staff and enhance current team.
- Provided formal feedback to team members and supervisor, boosting overall production and quality.
Education
Some College (No Degree) - Business
Essex County College/Rutgers University 9/90-9/93
Newark, NJSkills
- Team Building & Supervising
- Research, Analysis & Auditing skills
- Complex problem resolution
- Strategic Planning & Implementation
- Process Optimization/Improvements
- Effective time management
- Strong communication skills
- Expert in customer relations
- CMS/MCD proficient
- Knowledge of FDCPA and HIPAA regulatory compliance
- Computer applications proficient
Timeline
Recovery Resolutions Consultant
Optum, UnitedHealth Group
10.2022 - Current
Supervisor New Day Claims
Optum, UnitedHealth Group
10.2021 - 10.2022
Collections Specialist
Accurate Collection Services
03.2016 - 10.2021
Recovery Supervisor II
HORIZON BLUE CROSS BLUE SHIELD
01.2005 - 07.2013
Technical Support Analyst II
HORIZON BLUE CROSS BLUE SHIELD
08.2003 - 12.2004
Some College (No Degree) - Business
Essex County College/Rutgers University 9/90-9/93