Robin Russell
Bohemia
Summary
Many years of medical experience, results-driven, known for high productivity. Specialize in the improvement of workflow. Excellence in communication, problem-solving, and adaptability, ensuring seamless project finalization. Customer service etiquette. Productivity in revenue.
Overview
30
30
years of professional experience
2
2
Certifications
Work History
REG. ACCT.MGR: OVERPAYMENT MEDICAL CLAIM RECOVERY
UNITEDHEALTH CARE OPTUM
REMOTE
05.2017 - 08.2025
- Recovery auditor.
- Medical claims.
- JOB ELIMINATED
- Recovery of funds from all other insurance carriers, hospitals, anesthesia offices, and hospice.
- The providers would have a credit balance on their accounts that was due to overpayments back to UnitedHealthcare.
- Investigating contract pricing for coding, making sure the refund was correct.
- Applied knowledge and skills to complex audits. Resolved complex issues.
- Planned, prioritized, organized, and completed work, established.
- Worked independently, knowledge of DRG codes, CPT codes, UBs, medical terminology, and medical records.
- Ensure that overpayment/refund checks were properly applied to the correct refund claim after the audit.
- Communicate with the provider to ensure Optum UHC is meeting the needs and expectations of the provider.
- Working Relationship: Customer Service Etiquette.
- Work independently, remotely.
- Adhere to state and federal compliance policies, reimbursement policies, and contract compliance.
- Managed project timelines and resources to ensure timely completion of initiatives.
- Developed strategic plans aligning with organizational goals and regulatory requirements.
- Trained employees on additional job positions to maintain coverage of roles.
- Managed vendor relationships by negotiating contracts and ensuring timely delivery of goods and services.
- Developed and implemented strategic plans to achieve company objectives.
- Coordinated cross-departmental projects to ensure timely and successful completion.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Reviewed completed work to verify consistency, quality, and conformance.
Medical billing support analyst
Netsmart Technologies
Great River
09.2016 - 02.2017
- Facilitated billing for insurance carriers using Avatar PM across multiple clients nationwide.
- Provided comprehensive client support for Avatar PM billing issues and inquiries.
- Collaborated with insurance carriers to ensure timely payment processing.
- Generated revenue reports, analyzing data for actionable insights.
- Created detailed spreadsheets to summarize monthly revenue for clients.
- Diagnosed system faults, coordinating with IT specialists for resolution when necessary.
- Delivered technical support through various channels including phone and email.
- Conducted user acceptance testing and trained users on software functionalities.
Medical Collections Specialist
Northwell – NorthShore LIJ
Melville - New Hyde park
04.2000 - 08.2015
- Collected hospital accounts for NS LIJ, driving financial recovery initiatives.
- Managed patient accounts to ensure timely collection of outstanding balances.
- Communicated with patients regarding payment options and account inquiries.
- Advised patients on copays, deductibles, and coinsurance to clarify billing processes.
- Executed billing procedures using FCFA 1500 and UB92 forms with efficiency.
- Resolved account discrepancies by conducting evaluations and communicating directly with patients.
- Maintained customer service standards to encourage positive patient experiences.
- Fostered an efficient work environment through team collaboration and training efforts.
- Analyzed credit reports to verify assets, SSN, and contact information for collections support.
- Oversaw employee productivity by establishing monthly goals for finance and G/L departments.
Medical Collections Specialist
POM Recoveries
06.1995 - 03.2000
- Collections for Medical Accounts consisting of Co-pays – Deductibles-
- Out of network -Coinsurance
- Accounts were for Westchester Hospital, Physicians, Radiology accounts.
- Billing of claims for Physicians (When needed)
- Medical Collections specialist with over 5 years’ experience in health care debt recovery and patient account management.
- Exceeded targets by 15% through negotiation and resolution strategies.
- Maintained strict compliance with HIPPA and FDCPA regulations.
- Portfolio over 500 accounts
- Negotiated payment plans and settlements with delinquent patients.
- Customer service Etiquette
Education
Medical Billing & Coding specialist - ICD -10 certification
Hunter Business School
New York, NY06-2015
Associate of Arts - Finance Management
University of Phoenix
05-1990
LPN -
Boces BrookHaven NY
BrookHaven, NYSkills
- CREDIT & COLLECTIONS
- CUSTOMER SERVICE
- CONSUMER DEBT, BANKRUPTCY
- MEDICAL TERMINOLOGY
- ICD CODING
- FINANCE REVENUE
- INSURANCE CARRIERS
- HIPPAA REGULATIONS
- PHI
- NEGOTIATION SKILLS, COLLECTION LAWS
- TRAINING SKILLS
- MANAGEMENT SKILLS AUDITING MEDICAL CLAIMS
- Proficient in Microsoft Word and Excel, POWER PT
- Recovery auditing
- Medical claims processing
- Compliance adherence
- Vendor management
- Data analysis
- Revenue cycle management
- Client relationship management
- Billing procedures execution
- Cross-departmental coordination
- Effective communication
- Problem solving
- Attention to detail
- Strategic planning
- Customer service
- Contract management
- Decision-making
- Policy implementation
- Conflict resolution
- Goal setting
- Customer relationship management (CRM)
- Coaching and mentoring
- Documentation and reporting
- Clear communication
- Expectation setting
- Trend analysis
- Complex Problem-solving
- Performance management
- Time management
- Verbal and written communication
- Skype
- Work prioritization
- Revenue management
- MS office
REFERENCES FROM UHG OPTUM
- Diane, Dunlop, Diane.dunlop@optum.com
- Michael, Little, Michael.little@optum.com
- Karen, Robinowitz-Karen, Karen.Robinowitz@optum.com
- Kyle, Winter, Kyle.winter@optum.com
Custom
- THANK YOU FOR REVIEWING MY RESUME
- Robin Russell
Certification
ICD 10 Medical coder
Timeline
REG. ACCT.MGR: OVERPAYMENT MEDICAL CLAIM RECOVERY
UNITEDHEALTH CARE OPTUM
05.2017 - 08.2025
Medical billing support analyst
Netsmart Technologies
09.2016 - 02.2017
Medical Collections Specialist
Northwell – NorthShore LIJ
04.2000 - 08.2015
Medical Collections Specialist
POM Recoveries
06.1995 - 03.2000
Medical Billing & Coding specialist - ICD -10 certification
Hunter Business School
Associate of Arts - Finance Management
University of Phoenix
LPN -
Boces BrookHaven NY