Operations Management Consultant Manager - Division of Risk Management (Department of Financial Services)
- Fraud Investigations
- Supervising and training Staff
- Assign work and ensure of proper completion of work assignments
- Solving problems and making right decisions
- Evaluating several reports and activities relating to the improvement of management practices, conducting fact-finding research and organizing data into logical format for presentation in reports, documents and written materials
Workers Compensation Administrator - Division of Risk Management (Department of Financial Services)
(2021-02 - 2021-11)
- Supervising adjusters, managing complicated and highly litigated claims case load of 53 Settlements
- Handling personnel such as attendance, approving time sheets, leaves, performance evaluations
- Managed claims from initial investigation to back to work
- Training new adjusters, educating adjusters on policies and procedures within the bureau, lost wages, compensability questions, investigating and evaluating claims
- Evaluating adjuster's dashboard to see for any outstanding Tasks for proper completion of assignments like EDI tasks done timely
- Calculating Fraud Savings for adjusters
- Settlement of complex claims avoiding PTD exposure
- Fraud Investigations
- Educating Work Compensation Coordinators
Workers Compensation Analyst/Adjuster - Division of Risk Management (Department of Financial Services)
(2014-08 - 2021-02)
- Reviews and evaluates all work-related accident reports for completeness and clarity of data; analyzing data, as needed, to ensure compliance with policy and regulatory requirements
- Investigation of the claims regarding fraud
- Determines appropriateness and amount of worker's compensation claims; investigates individual claims for eligibility for workers' compensation benefits
- Ensures that all legal and procedural requirements are met for the processing of claims, in order to ensure proper and timely payment to employees and medical facilities
- Handled both new and PTD claims
- Communicates and interacts with medical professionals, support agencies and others to monitor and assess the progress of rehabilitation efforts, and to facilitate either return to work or, depending upon medical status of the claimant, placement into appropriate alternative positions within the Florida state
- Ensures compliance with all appropriate regulations and guidelines
- Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims assigned, as required by various regulatory agencies
- Makes strategic recommendations for reducing the frequency and severity of losses using a workers' compensation database and/or other claims data reports
- Designs and develops data bases, performs integrated data analyses, and prepares reports
- Training new employees
- Performs miscellaneous job-related duties as assigned
- 0 Defects in auditing
- Handling multiple projects as needed
- Extensive hands on experience in handling complicated claim and Permanent Total Disability claims and New claims
- Enacted as supervisor in during induction
- Review the wage statements for Accuracy and assisting the WC Coordinators and acted as Adjudication in settling claims who had no attorney
- Working with department attorneys
Billing Specialist/Supervisor/Surgical Coordinator - Ophthalmologist Office Ambulatory Surgery Center and Clinic
(2012-04 - 2014-08)
Roles and Responsibilities
- Code patient services and enter medical software
- Sort and file paperwork maintain contracts with state government with end of the year financial reports
- Ensure are reimbursed for all procedures
- Handle information about patient treatment, diagnosis, and related procedures to ensure proper coding
- Know several different coding systems, including Level 1 HCPCS and Level 2 HCPCS.ICD 10
- Follow up to see if a claim is accepted or denied
- Investigate rejected claim to see why denial was issued
- Getting Authorizations and eligibility of patients their deductibles and copays. From Insurance Companies for Office Visits and Surgeries
- Getting all the correspondence and paperwork ready and update for the Medicare Surveys, applications, Updating Safety Manuals and for Licensing for the Clinic and Ambulatory Surgery Center for AHCA (Agency of Health Care Administration)
- Preparing letters and notices to the insurance companies
- Claims Processing for Surgery and Clinic
- Training New Employees /Recruiting, Supervising Continuing Education requirements from CMS for Surgery Center and Clinic
- Creating financial data (Excel Spreadsheets) for State Contracts and clinic and Ambulatory
Project Manager, School of Business for Students - Florida State University
(2012-02 - 2012-08)
- Provide Leadership, Supervising and Managing the personnel make decisions; solve problems; develop unit procedures; develop records/files; conduct meetings on project deadlines
- Manage the employee hiring process; develop or update job descriptions; performance expectations, identify essential functions and knowledge, skills and abilities required
- Managing multiple projects and making sure the projects are finished timely
- Establish a budget plan of the projects
- Recruiting IT Personnel for each project
Onsite Interpreter/Transcriptionist/Translator - Southwestern State Hospital - Thomasville, GA
(2012-04 - 2012-06)
On Call Position Part Time
- Translating for Clients who do not speak English and only speak Native Foreign Languages like Hindi, Marathi and Telugu
- Perform data entry and data retrieval services, providing data for inclusion in medical records and for transmission to physicians
Medical Telephonic Interpreter - Pacific Interpreters
(2010-11 - 2012-01)
Work from Home as Independent Contractor Part Time
- Taking Phone Calls, which includes calls from Correction Facility, Hospitals, Emergency Services, Home Land Security, Immigration services, Court case calls sometimes
- Translating for Clients who do not speak English and only speak Native Foreign Languages like Hindi, Marathi and Telugu
- Communicating and translating the information from Native Language to English to clients and according to client's needs
Legal Liaison/Customer Care - FBL Law Firm Call Center - Pennsylvania
(2010-02 - 2011-02)
- Documenting all calls with regards to participant inquires accurately using Call Tracking System, Emails Monitor Call Tracking for responses from administrative team so call returns are done in a timely fashion
- Promoting teamwork and call center success
- Listen to and critique recorded conversations for purposes of improving customer skills.Organizing and prioritizes duties
- Interacting with the lawyers and sending them the editing and writing legal paper work and the clients information that was needed for the cases
- Filing the legal paper work and going through the contracts of the attorneys in every state and updating them
