MARJORIE BELANGER
San Marcos, CA 92078
mbelanger152@gmail.com
RELATIONSHIP BUILDING ● ORGANIZATION ● ANALYTICAL ● INTEGRITY
SUMMARY OF QUALIFICATIONS
Experienced, organized, and versatile professional who can excel at diverse tasks and flourish within challenging environments. A creative problem-solver who utilizes resources to improve performance and enhance operations. Excellent work ethic and reliability. Motivated by challenge and opportunity. Take pride in achieving goals within time, budget, and quality parameters. Can work independently or as part of a team environment. Personal characteristics include honesty, self-motivation, reliability, and integrity. Expert knowledge of managed healthcare contract payment methodology, accounts receivable revenue cycle, medical terminology, and outpatient medical coding. Certified Professional Coder (CPC). Relocated to California February 2011 and currently pursuing employment opportunities.
PROFESSIONAL EXPERIENCE
SENIOR NETWORK OPERATIONS REPRESENTATIVE 2007-10
HEALTHSPRING MEDICARE ADVANTAGE Memphis, TN
• Developed and maintained positive relationships with physicians, providers, and practice managers, resulting in a highly stable provider network.
• Researched and resolved complex claim and provider issues.
• Managed IPA of eleven primary care physicians with first year surplus.
• Developed strategies with Clinical Educator to achieve compliant hierarchical coding from participating providers.
SENIOR PROVIDER EDUCATION/ RELATIONS REPRESENTATIVE 2000-06
HUMANA MILITARY HEALTHCARE SERVICES Millington, TN
• Directed contracting, accreditation, administration and education support services.
• Researched and resolved complex claim and provider issues for types of providers (physician, hospital, ancillary).
• Ensured compliance with Department of Defense and TRICARE requirements.
PROVIDER NETWORKS REPRESENTATIVE 1996-99
MID-ATLANTIC MEDICAL SERVICES Virginia Beach, VA
• Assessed and sought to resolve provider questions or concerns related to contract interpretation, eligibility, capitation and claims issues for members converting to Mid-Atlantic Medical Services.
• Identified trends and coordinated with internal departments to correct root causes of problems.
OPERATIONS COORDINATOR 1996-98 Promoted to Provider Representative
• Verified health insurance member eligibility and coverage under direction of Inpatient Utilization Management Department.
• Assigned ICD-9 codes. Reviewed for pre-certification of surgeries using Millman and Roberts and determined if surgery criteria was met.
MEDICAL INSTRUCTOR 1993-96
ECPI COLLEGE OF TECHNOLOGY Virginia Beach, VA
• Instructor of medical terminology, transcription, medical insurance, ICD-9 and CPT codes, records management, computerized billing and patient scheduling.
OTHER PERTINENT EXPERIENCE
MEDICAL ADMINISTRATIVE ASSISTANT, TRANSCRIPTION AND CODING
University Hospital and Medical Center Jacksonville, FL 1980-1983
Duke University Eye Center Durham, NC 1983-1989
Athens Regional Medical Center Athens, GA 1990-1993
Performed medical transcription in radiology, ophthalmology, and radiation oncology. Assigned ICD-9 and CPT codes to reports. Reports included clinic notes, operative reports, history and physicals, and discharge summaries. Scheduled surgery, provided pre-operative patient education, obtained prior authorization for procedure(s).
EDUCATION AND TRAINING
ADULT EDUCATION M Ed DEGREE
UNIVERSITY OF GEORGIA Athens, GA
HEALTH OCCUPATIONS TEACHERS EDUCATION BS DEGREE
NORTH CAROLINA STATE UNIVERSITY Raleigh, NC
MEDICAL ASSISTING A.S. DEGREE
SAN DIEGO MESA COLLEGE
San Diego, CA
CERTIFICATIONS
● Certified Managed Healthcare Professional – Health Insurance Association of America
● Certified Professional Coder – American Association of Professional Coders
Registry ID# 01092289
(Served as 2010 Education Coordinator for Memphis Chapter)
COMPUTER SKILLS
● All Windows Venues ● Microsoft Word ● Excel ● Outlook
● Power Point ● Lotus Notes ● Internet
San Marcos, CA 92078
mbelanger152@gmail.com
RELATIONSHIP BUILDING ● ORGANIZATION ● ANALYTICAL ● INTEGRITY
SUMMARY OF QUALIFICATIONS
Experienced, organized, and versatile professional who can excel at diverse tasks and flourish within challenging environments. A creative problem-solver who utilizes resources to improve performance and enhance operations. Excellent work ethic and reliability. Motivated by challenge and opportunity. Take pride in achieving goals within time, budget, and quality parameters. Can work independently or as part of a team environment. Personal characteristics include honesty, self-motivation, reliability, and integrity. Expert knowledge of managed healthcare contract payment methodology, accounts receivable revenue cycle, medical terminology, and outpatient medical coding. Certified Professional Coder (CPC). Relocated to California February 2011 and currently pursuing employment opportunities.
PROFESSIONAL EXPERIENCE
SENIOR NETWORK OPERATIONS REPRESENTATIVE 2007-10
HEALTHSPRING MEDICARE ADVANTAGE Memphis, TN
• Developed and maintained positive relationships with physicians, providers, and practice managers, resulting in a highly stable provider network.
• Researched and resolved complex claim and provider issues.
• Managed IPA of eleven primary care physicians with first year surplus.
• Developed strategies with Clinical Educator to achieve compliant hierarchical coding from participating providers.
SENIOR PROVIDER EDUCATION/ RELATIONS REPRESENTATIVE 2000-06
HUMANA MILITARY HEALTHCARE SERVICES Millington, TN
• Directed contracting, accreditation, administration and education support services.
• Researched and resolved complex claim and provider issues for types of providers (physician, hospital, ancillary).
• Ensured compliance with Department of Defense and TRICARE requirements.
PROVIDER NETWORKS REPRESENTATIVE 1996-99
MID-ATLANTIC MEDICAL SERVICES Virginia Beach, VA
• Assessed and sought to resolve provider questions or concerns related to contract interpretation, eligibility, capitation and claims issues for members converting to Mid-Atlantic Medical Services.
• Identified trends and coordinated with internal departments to correct root causes of problems.
OPERATIONS COORDINATOR 1996-98 Promoted to Provider Representative
• Verified health insurance member eligibility and coverage under direction of Inpatient Utilization Management Department.
• Assigned ICD-9 codes. Reviewed for pre-certification of surgeries using Millman and Roberts and determined if surgery criteria was met.
MEDICAL INSTRUCTOR 1993-96
ECPI COLLEGE OF TECHNOLOGY Virginia Beach, VA
• Instructor of medical terminology, transcription, medical insurance, ICD-9 and CPT codes, records management, computerized billing and patient scheduling.
OTHER PERTINENT EXPERIENCE
MEDICAL ADMINISTRATIVE ASSISTANT, TRANSCRIPTION AND CODING
University Hospital and Medical Center Jacksonville, FL 1980-1983
Duke University Eye Center Durham, NC 1983-1989
Athens Regional Medical Center Athens, GA 1990-1993
Performed medical transcription in radiology, ophthalmology, and radiation oncology. Assigned ICD-9 and CPT codes to reports. Reports included clinic notes, operative reports, history and physicals, and discharge summaries. Scheduled surgery, provided pre-operative patient education, obtained prior authorization for procedure(s).
EDUCATION AND TRAINING
ADULT EDUCATION M Ed DEGREE
UNIVERSITY OF GEORGIA Athens, GA
HEALTH OCCUPATIONS TEACHERS EDUCATION BS DEGREE
NORTH CAROLINA STATE UNIVERSITY Raleigh, NC
MEDICAL ASSISTING A.S. DEGREE
SAN DIEGO MESA COLLEGE
San Diego, CA
CERTIFICATIONS
● Certified Managed Healthcare Professional – Health Insurance Association of America
● Certified Professional Coder – American Association of Professional Coders
Registry ID# 01092289
(Served as 2010 Education Coordinator for Memphis Chapter)
COMPUTER SKILLS
● All Windows Venues ● Microsoft Word ● Excel ● Outlook
● Power Point ● Lotus Notes ● Internet