Summary
Overview
Work History
Education
Skills
Timeline
Generic

Maria Kostova

Scottsdale,AZ

Summary

Reliable business professional with experience in project management, process improvement and financial analysis. Adept at analyzing data to identify trends and developing strategies to improve efficiency.

Overview

22
22
years of professional experience

Work History

Medicare and Medicaid Complaint & Appeal Consultant

Aetna/CVS Health
01.2012 - Current
  • Identify trends and emerging issues through monitoring and reporting these to impacted business areas
  • Deliver internal quality reviews, provide appropriate support in third party audits, customer meetings and regulatory meetings
  • Lead research and analysis, with both internal and external partners to successfully resolve member and provider complaints and appeals involving claims, authorizations, benefits and other communication for both Medicare and Medicaid lines of business
  • Prepare files and participate in Medicare and Compliance Effectiveness Audits
  • Educate analysts and business units on identified issues and potential risk
  • Research and respond to Executive complaints, Department of Insurance, Attorney General complaints and appeals on behalf of members and providers assigned
  • Highly knowledgeable and proficient with Medicare and Medicaid regulations
  • Knowledge of Independent Review Entity (IRE) decision and regulations
  • Collaborate with customers, management, and sales team to better understand customer needs and recommend appropriate solutions
  • Assist with complaint gap analyses and risk assessments.
  • Analyze complaint data to identify root causes, trends, issues and regulatory concerns.
  • Deliver outstanding service to clients to maintain and extend relationship for future business opportunities.

Senior Account & Collection Specialist

University of Pittsburgh Medical Center
03.2004 - 12.2011


  • Partnered with billing analyst department to investigate and remedy any gross margin trend issues.
  • Assisted in implementing procedures and policies to facilitate timely payments.
  • Evaluated aging reports to identify accounts to be included in monthly outbound calls.
  • Researched portals issues related to non-payment within e-billing vendor portals.
  • Maintained accurate records of customer accounts, payments and payment plans.

Accounts Receivable

PER-SE TECHNOLOGIES
04.2003 - 03.2004
  • Prepared appeals and reviews, information requests and bulk rejections for incoming payments.
  • Processed and recorded accounts receivable transactions to facilitate prompt collection of customer payments.
  • Presented audit findings to accounting manager after reviewing results and paperwork.
  • Effectively communicated with clients about payment needs and kept updated, detailed and accurate ledgers.

Billing Associate

ECP BILLING SERVICES
01.2002 - 04.2003
  • Worked with multiple departments to check proper billing information.
  • Prepared and submitted monthly billing reports to management for financial overview.
  • Identified, researched, and resolved billing variances to maintain system accuracy and currency.
  • Developed and maintained billing procedures to make timely payments.
  • Processed and verified invoices to secure accuracy of billing information.
  • Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.

Education

Bachelor of Arts - Pedagogy

SOUTHWEST UNIVERSITY “NEOFIT RILSKI"
Blagoevgrad

Effective Communication Time/Stress Management - New Choices Career And Professional Development

COMMUNITY COLLEGE OF ALLEGHENY COUNTY
Pittsburgh, PA

Health Claims Examiner - Medical Biller Program

MEDIAN SCHOOL OF ALLIED HEALTH CAREERS
Pittsburgh, PA

Skills

  • Excellent people skills
  • Strong research, investigative, analytical skills
  • Ability to exercise critical thinking skills and use logic and reasoning to assess and resolve problems
  • Interact and collaborate with medical professionals
  • Communicate for impact
  • Ensure project discipline
  • Create accountability
  • Collaborate for results
  • Drive culture of compliance
  • Excellent organizational and time management skills resulting in well-balanced workflow

Timeline

Medicare and Medicaid Complaint & Appeal Consultant

Aetna/CVS Health
01.2012 - Current

Senior Account & Collection Specialist

University of Pittsburgh Medical Center
03.2004 - 12.2011

Accounts Receivable

PER-SE TECHNOLOGIES
04.2003 - 03.2004

Billing Associate

ECP BILLING SERVICES
01.2002 - 04.2003

Bachelor of Arts - Pedagogy

SOUTHWEST UNIVERSITY “NEOFIT RILSKI"

Effective Communication Time/Stress Management - New Choices Career And Professional Development

COMMUNITY COLLEGE OF ALLEGHENY COUNTY

Health Claims Examiner - Medical Biller Program

MEDIAN SCHOOL OF ALLIED HEALTH CAREERS

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Maria Kostova