Robin Webb
Healthcare Claims Investigation
Brooklyn,NY
Summary
Detail-oriented Investigator with strong leadership Skills and history in security management. Offering exceptional communication skills and network of community resources. Adept at partnering with colleagues and other agencies to gather investigative data. Adept at analyzing and uncovering trends in complex data. Hardworking with insight and experience in claims investigations. Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Business-minded with exemplary skills in customer service, time management and service coordination. Bringing over 30+ years of related experience combined with superior mathematical abilities. Pursuing similar position with expanding company. Negotiates peaceful resolutions of all claims with emphasis on fairness and thoroughness. Trustworthy and dependable. Claims Examiner with deep knowledge of medical and dental claims industry. Claims. Excellent skills auditing information to process claims. Detailed Adjuster with 20+ years of experience in corporate insurance claims. Impactful skills preparing operational reports, presenting information to audiences and approving claim payouts. Resourceful professional promoting 20+ years of expertise assessing coverage and overseeing claims review. Leverages well-developed communication skills to deliver information to policyholders. Results-oriented exceptional leadership and communication skills.
Overview
32
32
years of professional experience
Work History
Healthcare Claims Investigator (HCI)
NYCHHC/Kings County Hospital Center
08.2018 - Current
- Under supervision, and with informed judgement conduct investigations in NYC Health and Hospitals Corporation (HHC) facilities to: Use accounts receivable reports to verify claims validity, whether claims require retroactive authorization requests or appeal for not medically necessary claims
- Call medical carriers to inquire when claims were received and what is the determination of claims received
- Create correspondence for claim appeals and submit to carrier with all supporting documentation
- Determine the ability of patients and their legally responsible relatives to pay for hospital or health care charges and take the necessary actions to bill and collect for these services
- Explore alternative sources for payment of hospital or health care services rendered
- Verify, modify, and code demographic and insurance data obtained from source documents, and enter such data into a computerized system
- Perform collection functions to obtain maximization of a hospitals or healthcare facility’s revenue
- Create adjustments when necessary
- Track denied claims and track claim appeals.
- Directed claims negotiations within allowable limit of and supported successful litigations for advanced issues.
Customer Service Manager (CSM)
AHRC NYC- Brooklyn Employment and Business Services
06.2017 - 05.2018
- Provide top quality customer service to clients, their families and their advocates, internal and external staff
- Maintain all OPWDD files for pre-employment clients, ensuring all ISP meetings are held with MSCs and ensure all SEMP plans comply for QA and AHRCNYC standards, CQL and Discovery interviews
- Communicating with the clients’ families regarding program/employment placements, participation in the program
- Independent service plan meetings for participant progress measures
- Write daily service notes for each customer for billing purposes and track of each client hours for OPWDD billing
- Hosting job club to teach interviewing skills, making phone calls to clients once per week for billing purposes
- Keeping track of client’s employment and working with the Account Executives to facilitate job placements
- Recording all attendance of program participants and/or entering service notes on-line
- Referring participants for job placement
- Using Wildwood Cloud Services portal to enter narrative of daily services provided
- Requesting billing hours for vocational needs using narrative information to describe needs for OPWDD
- Using Excel to track and report attendance, those employed, those terminated, those transferred to other programs, etc.
Senior Patient Accounts Assistant (Supervisory)
New York University College of Dentistry
02.2000 - 02.2016
- Advise clinic management and staff on best practices for handling all aspects of patient accounts and claims reconciliation
- Trained new hires, temp staff, and non-departmental staff in all aspects of dental billing and departmental procedures, facilitated informative meetings for staff, middle management and upper management
- Published reference manuals for clinic staff and management; published training manuals for department and dental university staff and management
- Process all disciplines of dental claims, including Orthodontics using NY State MMIS and managed care reference manuals, E-Paces and EMEDNY and commercial insurance guidelines both manually and electronically
- Allocate payments from NY State Medicaid, managed care plans and commercial insurance, balancing entries and reconciling account balances, adjustments, write-offs and collections of claims past 90 days
- Receiving cash, check, credit card and electronic funds transfer to allocate per account using reports and spreadsheets to discover any problems/issues.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Passionate about learning and committed to continual improvement.
- Managed time efficiently in order to complete all tasks within deadlines.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Strengthened communication skills through regular interactions with others.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Learned and adapted quickly to new technology and software applications.
- Proved successful working within tight deadlines and a fast-paced environment.
- Developed and maintained courteous and effective working relationships.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Patient Accounts Billing Assistant Staff /Data Entry
New York University College of Dentistry
03.1992 - 01.2000
- Track claims denial reasons, denial frequencies and contractual issues using spreadsheets
- Audit patient accounts and adjust in processing refund requests, etc
- Successful project management for middle and upper management and senior management in reference to Dental Van development and billing projects and staff management and leadership on those projects and others.
Education
Bachelor of Science - Healthcare Management (Community Health)
New York University School of Continuing And Professional Studies
New York, NY05.2014
Applied Associate in Science - Healthcare Administration
New York University College of Dentistry
New York, NY05.2009
Skills
- Claim Analysis
- Detailed report writing
- Ethical and honest
- Calm in crisis situations
- Continuous Improvement
- Records Management
- Due diligence
- Data review
- Research abilities
Additional Work Experience
- Private practice consulting, provider credentialing, dental office set up, claims management.
- Obtained more than $50,000 in 4 months of $85K in outstanding receivables (2008-2009) while working only on Saturdays as independent consultant for newly established private practice, credentialing, training private practice staff with all insurance and Medicaid, consulting.
Accomplishments
- Obtained transportation funding from NY State for NYU’s Medicaid and HMO patients (2000)
- Successfully managed and lead NY State OIG audit while locating over $250K in unpaid Medicaid payments (2007)
- Collaborated with IT and Dentrix staff in customizing dental center’s acquisition of Dentrix dental software (1999-2001…) 1st Dentrix Enterprise version
- Published policy and procedure guides for department and clinics and for cross-training staff
- Introduced Synchronized Systems and E Paces to department to handle Medicaid eligibility for the department and dental clinics
Areas Of Knowledge Experience
- Accounts Receivable
- Supervisory Skills
- Training, Coaching, Development
- Claims and Account Reconciliation
- Healthcare Compliance
- Billing Processes/ HIPPA/EDI/EHR
- Auditing/Analysis
- Policies and Procedures
- CSM /HEDIS /EPACES/EMEDNY/EDI
- Dentrix/aXium/ EPIC
- EMDEON/Pivot Tables/Formulas
- Provider credentialing. CQI/TQM/TQI
Timeline
Healthcare Claims Investigator (HCI)
NYCHHC/Kings County Hospital Center
08.2018 - Current
Customer Service Manager (CSM)
AHRC NYC- Brooklyn Employment and Business Services
06.2017 - 05.2018
Senior Patient Accounts Assistant (Supervisory)
New York University College of Dentistry
02.2000 - 02.2016
Patient Accounts Billing Assistant Staff /Data Entry
New York University College of Dentistry
03.1992 - 01.2000
Bachelor of Science - Healthcare Management (Community Health)
New York University School of Continuing And Professional Studies
Applied Associate in Science - Healthcare Administration
New York University College of Dentistry
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