atbloretta1
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Looking for remote billing/ coding oppotunities for my small home-based business:
PO Box 685
Upland, CA 91785
(909) 946-4543 Ofc Phone/ Fax (909) 982-8595 Home Phone/ Fax (909) 261-4194 cell phone
email: ATBLoretta@Yahoo.com
Loretta Wolter-Pinkowski
Qualifications
20+ years experience demonstrated creative problem solving and analytical skills;
managing, training, planning, administering and leading.
20 years Healthcare Insurance evaluation and negotiation skills experience with progressive responsibility to management.
Critical Thinking Process Skills - Ability to work independently and also effectively with others in a team environment
2002-present ATB Medical Services Upland, CA
Owner-Worker's Comp and Personal Injury Billing Specialist, Lien Rep
Currently managing team of claims billers/ collectors for client doctors in multiple facilities statewide-Worker's Comp and PI specialists, Group Health insurance, Medicare. File Liens and work with attorneys, represent clients as Hearing Representative with strong litigation focus. Appear at court or Board proceedings and aggressively advocate the position of the company and/or the account. Remain current on related legal and regulatory governances and changes. Strong understanding of Workers Compensation law and litigation procedures in both WCAB and Small Claims Court. Exhibit and encourage business integrity.
2008- present Platt College-Ontario Campus Ontario, CA
Adjunct Faculty Medical Administrative Specialist degree program-Platt College
Strong verbal & written communication skills. Computer proficient. Strong organizational skills.
1999 -2001 Kaiser Permanente -SCPMG Pasadena, CA
Utilization Analyst, Centralized Outside Utilization Management, Case Coordination Center
Familiar with mainframe, FilemakerPro, legacy systems, MS Office products. Set up access to these systems for all new RNs. Reporting responsibilities using Excel spreadsheets & graphs for COUM Manager. Verify eligibility, assignment & process referrals for visiting out of area Kaiser members & members hospitalized in NON-KFH.
Systems Administrator, Claims Administration Department
Developed and wrote policies and procedures for Systems Administrators on provider file maintenance, 1099 audits, adding out-of area members, eligibility & benefits procedures.
Part of IT team whom analyzed & resolved Y2K & other programming issues relating to Foundation Benefits System. Developed in-service for claim routing issues and System Error Matrix.Edited COOL-Contracts On Line-CAD's Web page. Trained additional Systems Admins. & Strike teams. Provided support to CAD supervisors through In-house training of claims adjustors & indexing personnel.Provided support to Affiliated Contracts department, Network Expansion Market, and outside Referral desk MSA's.
1996-1998 Apria Healthcare, Inc. Tustin, CA
Supervisor - Government Infusion Accounts Receivables
Worked closely with IS in JAD sessions to develop automated M-Cal claims processing & IV
Pharmacy attachments. Increased reimbursement percentage to trailing 90 day A/R to best in the region. Lowest >180 A/R in the region. Analyzed / solved complex claim issues. Monitored for government compliance. Calculated government allowances. Screened high dollar claims for adjudication. Interpreted contracts for maximum reimbursement. Hired, trained and managed Medicare and Medi-Cal IV A/R representatives. Division closed.
1994-1996 Memorial Medical Group, Inc. Long Beach, CA
Medical Insurance Billing and Collection Specialist
Cardiology insurance billing and collections for a 45-doctor group. Collected huge back payments from local IPA prior to their bankruptcy.
1989-1994 Memorial Cardiology Med Group Long Beach, CA
Accounts Representative - Cardiology insurance billing for a seven-doctor group.
1991-1995 Claremont Adult School Claremont, CA
Evening Instructor- Medical Terminology, Office Procedures, Insurance Billing. Designed and improved teaching manuals and course materials. Taught briefly at Nova in Long Beach.
Loretta Wolter-Pinkowski
Page two
Education University of Phoenix Ontario, Diamond Bar and Pasadena, CA Bachelor of Science Degree in Information Technology. Coursework completed includes: Management: Theory, Practice, Application. Computers & Information Processing. Organizational Behavior. Marketing. Ethics in Information Technology. Fundamentals of Business Systems Development. Project Planning & Implementation. The Internet: Concepts & Applications. Intro to Operating Systems. Network & Telecommunications Concepts I & II. Programming Concepts: C++. Introduction To Object-Oriented Programming: Visual Basic 6.0,Database Concepts, XML, Database Management Systems, Advanced Visual Basic, Web Programming I & II, Critical Thinking, SQL for Business, Intro to Unix, Windows 2000, Business Systems Development II.
Concorde Career Institute Fast Track IT Program Garden Grove, CA
Visual Basic and Web Development 300-hour intensive training program designed to qualify the graduate for a computer programming position as a web developer.
UCLA Extension and Cal Poly Pomona, CA
Adult Vocational Education Credential in Designated Subjects- Medical Billing and Coding
Chaffey Community College Alta Loma, CA
Fashion Institute of Design & Merchandising Los Angeles, CA
Associates Degree in Retail Management and Fashion Merchandising
West Valley Community College Campbell, CA
Prior Prior Management / Financial Experience:
Currently run medical billing & collections and lien rep business specializing in Worker's Compensation and Personal Injury collections. Government Supervisor Infusion Accounts Receivable for Apria Healthcare, Inc. Tustin for three years 1996-1998: Hired and trained account reps for Medi-Cal and Medicare Infusion billing and collections including extensive government compliance issues. Accounts receivable billing and collections specialist for cardiology physicians for seven years 1989-1996. Collected 97% of payments due from Independent Practitioners Assoc., prior to IPA bankruptcy. Trend forecasting, prepared detailed sales and purchasing budgets, increased sales and profit margin over plan by 50-300% in both manufacturing and retail fields.
*Sales Manager for wholesale garment manufacturers two years 1988-1989 before career change to medical field.
National Sales Manager Peaches My Love/ Emje Dresses Los Angeles, CA
Hired, managed national sales force, purchased fabric, merchandised moderate missy dress lines, managed sales accounts with major stores for 2 years 1988-1989. Hired national sale force and expanded territorial sales 300%
Divisional Merchandise Manager-Harris' Department Stores San Bernardino, CA
Hired and managed staff of $6 million division, Junior sportswear, dresses & accessories. 47% gross margin. Turned stocks 9-10 times per year with 3 basics departments. Prepared detailed sales & purchasing budgets. Forecasted trends and off shore purchases for Junior Apparel at Harris' Department Stores for 6 years 1981-1987
Associate Jr. Petite Dress Buyer, May Company -Los Angeles, CA
Joined the mid-management training program. Promoted after 6 months then again after 1 yr, and again promoted. Projected, planned and bought for Junior Petite Dress Dept. Doubled the sales projections in the first year. Interviewed, hired and managed staff, assigned workflow, evaluated employees for corrective action.
Training/ Marketing Experience:
Currently Adjunct Faculty for Medical Administrative Specialist degree program-Platt College, Ontario, CA.
Also currently train externs for permanent positions in billing and coding for ATB Medical Services, UEI and Platt Colleges and client doctors. Claremont Adult School and Nova Evening Instructor for five years 1991-1995: Medical Terminology, Medical Front Office and Medical Insurance Billing and Coding; Designed and improved teaching manuals and course materials.
PO Box 685
Upland, CA 91785
(909) 946-4543 Ofc Phone/ Fax (909) 982-8595 Home Phone/ Fax (909) 261-4194 cell phone
email: ATBLoretta@Yahoo.com
Loretta Wolter-Pinkowski
Qualifications
20+ years experience demonstrated creative problem solving and analytical skills;
managing, training, planning, administering and leading.
20 years Healthcare Insurance evaluation and negotiation skills experience with progressive responsibility to management.
Critical Thinking Process Skills - Ability to work independently and also effectively with others in a team environment
2002-present ATB Medical Services Upland, CA
Owner-Worker's Comp and Personal Injury Billing Specialist, Lien Rep
Currently managing team of claims billers/ collectors for client doctors in multiple facilities statewide-Worker's Comp and PI specialists, Group Health insurance, Medicare. File Liens and work with attorneys, represent clients as Hearing Representative with strong litigation focus. Appear at court or Board proceedings and aggressively advocate the position of the company and/or the account. Remain current on related legal and regulatory governances and changes. Strong understanding of Workers Compensation law and litigation procedures in both WCAB and Small Claims Court. Exhibit and encourage business integrity.
2008- present Platt College-Ontario Campus Ontario, CA
Adjunct Faculty Medical Administrative Specialist degree program-Platt College
Strong verbal & written communication skills. Computer proficient. Strong organizational skills.
1999 -2001 Kaiser Permanente -SCPMG Pasadena, CA
Utilization Analyst, Centralized Outside Utilization Management, Case Coordination Center
Familiar with mainframe, FilemakerPro, legacy systems, MS Office products. Set up access to these systems for all new RNs. Reporting responsibilities using Excel spreadsheets & graphs for COUM Manager. Verify eligibility, assignment & process referrals for visiting out of area Kaiser members & members hospitalized in NON-KFH.
Systems Administrator, Claims Administration Department
Developed and wrote policies and procedures for Systems Administrators on provider file maintenance, 1099 audits, adding out-of area members, eligibility & benefits procedures.
Part of IT team whom analyzed & resolved Y2K & other programming issues relating to Foundation Benefits System. Developed in-service for claim routing issues and System Error Matrix.Edited COOL-Contracts On Line-CAD's Web page. Trained additional Systems Admins. & Strike teams. Provided support to CAD supervisors through In-house training of claims adjustors & indexing personnel.Provided support to Affiliated Contracts department, Network Expansion Market, and outside Referral desk MSA's.
1996-1998 Apria Healthcare, Inc. Tustin, CA
Supervisor - Government Infusion Accounts Receivables
Worked closely with IS in JAD sessions to develop automated M-Cal claims processing & IV
Pharmacy attachments. Increased reimbursement percentage to trailing 90 day A/R to best in the region. Lowest >180 A/R in the region. Analyzed / solved complex claim issues. Monitored for government compliance. Calculated government allowances. Screened high dollar claims for adjudication. Interpreted contracts for maximum reimbursement. Hired, trained and managed Medicare and Medi-Cal IV A/R representatives. Division closed.
1994-1996 Memorial Medical Group, Inc. Long Beach, CA
Medical Insurance Billing and Collection Specialist
Cardiology insurance billing and collections for a 45-doctor group. Collected huge back payments from local IPA prior to their bankruptcy.
1989-1994 Memorial Cardiology Med Group Long Beach, CA
Accounts Representative - Cardiology insurance billing for a seven-doctor group.
1991-1995 Claremont Adult School Claremont, CA
Evening Instructor- Medical Terminology, Office Procedures, Insurance Billing. Designed and improved teaching manuals and course materials. Taught briefly at Nova in Long Beach.
Loretta Wolter-Pinkowski
Page two
Education University of Phoenix Ontario, Diamond Bar and Pasadena, CA Bachelor of Science Degree in Information Technology. Coursework completed includes: Management: Theory, Practice, Application. Computers & Information Processing. Organizational Behavior. Marketing. Ethics in Information Technology. Fundamentals of Business Systems Development. Project Planning & Implementation. The Internet: Concepts & Applications. Intro to Operating Systems. Network & Telecommunications Concepts I & II. Programming Concepts: C++. Introduction To Object-Oriented Programming: Visual Basic 6.0,Database Concepts, XML, Database Management Systems, Advanced Visual Basic, Web Programming I & II, Critical Thinking, SQL for Business, Intro to Unix, Windows 2000, Business Systems Development II.
Concorde Career Institute Fast Track IT Program Garden Grove, CA
Visual Basic and Web Development 300-hour intensive training program designed to qualify the graduate for a computer programming position as a web developer.
UCLA Extension and Cal Poly Pomona, CA
Adult Vocational Education Credential in Designated Subjects- Medical Billing and Coding
Chaffey Community College Alta Loma, CA
Fashion Institute of Design & Merchandising Los Angeles, CA
Associates Degree in Retail Management and Fashion Merchandising
West Valley Community College Campbell, CA
Prior Prior Management / Financial Experience:
Currently run medical billing & collections and lien rep business specializing in Worker's Compensation and Personal Injury collections. Government Supervisor Infusion Accounts Receivable for Apria Healthcare, Inc. Tustin for three years 1996-1998: Hired and trained account reps for Medi-Cal and Medicare Infusion billing and collections including extensive government compliance issues. Accounts receivable billing and collections specialist for cardiology physicians for seven years 1989-1996. Collected 97% of payments due from Independent Practitioners Assoc., prior to IPA bankruptcy. Trend forecasting, prepared detailed sales and purchasing budgets, increased sales and profit margin over plan by 50-300% in both manufacturing and retail fields.
*Sales Manager for wholesale garment manufacturers two years 1988-1989 before career change to medical field.
National Sales Manager Peaches My Love/ Emje Dresses Los Angeles, CA
Hired, managed national sales force, purchased fabric, merchandised moderate missy dress lines, managed sales accounts with major stores for 2 years 1988-1989. Hired national sale force and expanded territorial sales 300%
Divisional Merchandise Manager-Harris' Department Stores San Bernardino, CA
Hired and managed staff of $6 million division, Junior sportswear, dresses & accessories. 47% gross margin. Turned stocks 9-10 times per year with 3 basics departments. Prepared detailed sales & purchasing budgets. Forecasted trends and off shore purchases for Junior Apparel at Harris' Department Stores for 6 years 1981-1987
Associate Jr. Petite Dress Buyer, May Company -Los Angeles, CA
Joined the mid-management training program. Promoted after 6 months then again after 1 yr, and again promoted. Projected, planned and bought for Junior Petite Dress Dept. Doubled the sales projections in the first year. Interviewed, hired and managed staff, assigned workflow, evaluated employees for corrective action.
Training/ Marketing Experience:
Currently Adjunct Faculty for Medical Administrative Specialist degree program-Platt College, Ontario, CA.
Also currently train externs for permanent positions in billing and coding for ATB Medical Services, UEI and Platt Colleges and client doctors. Claremont Adult School and Nova Evening Instructor for five years 1991-1995: Medical Terminology, Medical Front Office and Medical Insurance Billing and Coding; Designed and improved teaching manuals and course materials.