MARCUS HILLIAN
Oak Hills ,CA
Summary
Detail-oriented team player with strong organizational skills. Track record of building strong relationships and maintaining calm demeanor under pressure. Utilizes effective negotiation techniques and clear communication to mediate disputes.
Overview
6
6
years of professional experience
Work History
Provider Dispute Resolution Coordinator
Alignment Healthcare
Anaheim, CA
11.2021 - Current
- Improves case resolution times by streamlining processes and implementing efficient communication strategies.
- Corresponds with delegated entity as needed to obtain appropriate records for payment information
- Assist in preparing and reviewing cases for regulatory and other health plan audits daily. (approximately 20-30 cases)
- Ensures privacy and security of PHI (Protected Health Information) as outlined in department policies and procedures relating to HIPPA Compliance.
- Reviews and processes provider appeal and dispute determinations according to CMS, contractual and processing guidelines. Issues appropriate documentation and payments accurately and timely.
- Collaborates with cross-functional teams to identify areas for improvement in dispute resolution procedures.
- Maintains accurate records of all disputes, ensuring compliance with industry regulations and company policies.
Pipeline Manager
Secure One Capital
Costa Mesa, CA
10.2020 - 07.2021
- Developed and managed executive mortgage bankers' pipeline
- Conducted regular reviews of operating procedures to identify areas for improvement that ultimately boosted productivity levels.
- Established effective systems for tracking progress on various projects using key performance metrics that accurately captured overall success rates.
- Ensured compliance with all relevant regulations, maintaining accurate documentation for audits and inspections.
- Managed approximately 20 inbound/outbound calls, emails and faxes per day from customers.
Member Service Representative
Alignment Healthcare
Anaheim, CA
08.2019 - 02.2021
- Facilitated the resolution of patient concerns regarding health plans and benefits
- Managed approximately 40-50 incoming calls per day from customers
- Collaborated with team members to ensure seamless operations during peak hours or staff shortages.
- Built rapport with members by engaging in genuine conversations and demonstrating a commitment to their financial wellbeing.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
Front Office Coordinator
Southland Physical Therapy
Irvine, CA
04.2019 - 08.2019
- Developed and managed executive mortgage bankers' pipeline
- Conducted regular reviews of operating procedures to identify areas for improvement that ultimately boosted productivity levels.
- Established effective systems for tracking progress on various projects using key performance metrics that accurately captured overall success rates.
- Ensured compliance with all relevant regulations, maintaining accurate documentation for audits and inspections.
- Managed approximately 20 inbound/outbound calls, emails and faxes per day from customers.
Education
Undergraduate Studies - Communications
Old Dominion University
Norfolk, VASkills
- Dispute Analysis, Interpersonal skills, Analytical thinking, Information collection, Document preparation, Ethical standards, Research, Attention to detail, Time management, Teamwork and collaboration, Case management, Adaptability and flexibility
Timeline
Provider Dispute Resolution Coordinator
Alignment Healthcare
11.2021 - Current
Pipeline Manager
Secure One Capital
10.2020 - 07.2021
Member Service Representative
Alignment Healthcare
08.2019 - 02.2021
Front Office Coordinator
Southland Physical Therapy
04.2019 - 08.2019
Undergraduate Studies - Communications
Old Dominion University