MICHELLE LEIBOWITZ
Dover,DE
Work Preference
Summary
Dynamic professional with strong problem-solving abilities and a keen willingness to learn, excelling in communication and collaboration. Poised to contribute significantly to team success while driving outstanding results. Readiness to tackle new challenges!
Overview
31
31
years of professional experience
Work History
Director of Operations (TPA)
HCPC of NJ
09.2018 - Current
- Established and monitored quality assurance standards to achieve operational excellence.
- Collaborated with union representatives, employers, and stakeholders to address concerns and implement effective solutions
- Conducted audits and prepared detailed reports to ensure transparency and accountability in fund management.
- Discreetly, maintaining strict confidentiality at all times as required by company policy or legal regulations.
- Internal audits to assess compliance with financial regulations and operational procedures.
Medical Office Specialist
Kent Pulmonary Associates
02.2013 - 05.2018
- Schedule / confirm patient diagnostic appointments, surgeries, or medical consultations in all 3 locations.
- Faxing, Email, Scanning Documentation, Multi-task/ Answered multi-line phone system, routing calls
- Addressed patient inquiries promptly, providing clear explanations about treatment plans, insurance coverage, billing processes, or other concerns as needed.
- Maintained patient databases and updated information in alignment with HIPAA protocols.
- Managed pre-certifications and verified insurance coverage to obtain authorization.
Talent Guardian and Tour Manager
Broadway National Tour
05.2009 - 12.2013
- Managed all logistics for a minor performer, including travel arrangements, housing, and scheduling for a multi-city national tour.
- Ensured compliance with all state and federal child labor laws, including on-set supervision, regulated working hours, and educational requirements.
- Acted as the primary liaison between the child, production staff, agents, and publicists, ensuring clear and consistent communication.
- Oversaw the child's daily needs, balancing performance demands with education, nutrition, and personal development.
- Cultivated a supportive and professional environment, managing the challenges of touring while prioritizing the child's well-being.
Manager of Operations
Health Care Payers Coalition of NJ
04.2000 - 05.2009
- Eligibility, customer service, managed care, Claim Administrator, HIPAA compliance, review and consult on plan benefits & changes, and personalized customer service.
- Provided direct support to Unions, primary care and specialty care providers regarding utilization, authorization, and referral.
- Examined information including authorizations, payments, denials, COB of benefits, and eligibility.
- Processed claims including complex cases, accordance with company policies/procedures.
- Investigates, analyzes and resolve outstanding issues.
- Communicating with Supervisors, Peers, or Subordinates via monthly reports.
Senior Medical Claims Examiner
Aetna Formerly Prudential Health Insurance
04.1995 - 04.2000
- Entered claim data accurately and timely according to the production goals.
- Maintained compliance with industry regulations and company policies while evaluating medical claims for accuracy and legitimacy.
- Report outstanding payments collected, past-due over payments. Re process claim after recouping of over payment.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Reviewed policy coverage details meticulously, ensuring accurate determination of benefits payable in each case.
Education
High School Diploma -
North Brunswick TWP High School
North Brunswick, NJ 05.2001 -
Skills
Claims processing proficiency
Timeline
Director of Operations (TPA)
HCPC of NJ
09.2018 - Current
Medical Office Specialist
Kent Pulmonary Associates
02.2013 - 05.2018
Talent Guardian and Tour Manager
Broadway National Tour
05.2009 - 12.2013
High School Diploma -
North Brunswick TWP High School
05.2001 -
Manager of Operations
Health Care Payers Coalition of NJ
04.2000 - 05.2009
Senior Medical Claims Examiner
Aetna Formerly Prudential Health Insurance
04.1995 - 04.2000