Hello Everyone,

I am trying to update my resume to include some duties
that I perform on a daily basis, but for some reason, I am either lost
for words or having a brain freeze. I have been trying to do this for
about 3 months now because I am looking for an at home position or a
position with a company where my certifications will be put to good
use. Ok, sorry for the long spill but here goes. I am seeking ways to
word these:

On a daily basis I work denials. Our physician billing was outsourced
to a company in another state, so everyday I go into the reimbursement
manager and check denials. The company will give the reason or reasons
why the claims were denied such as, dx inconsistent with procedure,
need auth number to process claim, pending to practice for auth to
write off because pt was seen during post op period, medical records
needed to process claim, insurance company requesting medical records,
insured cannot be identifed, etc. So I go in and provide the requested
information. I either scan the medical records into the EMR, provide
the correct dx, etc. Whatever is being requested I submit it so that
the claim can be refiled. Can someone help me re-word this description
in a more professional manner for my resume.

Another thing, we have been open for 2 years. The physicians that are
employed at the center all have private practices. About 70 % of our
claims are denied or become the patients responsibilty because the
insurance companies are saying that the physicians are out of network
or the physicians are non participating providers. This happened
because when the center first opened no one notified the insurance
companies that the physicinas would be practicing with the company. We
have different tax id numbers and new W-9 forms were generated for our
specific group, but the insurance companies did not know that. So what
I have been doing is calling all the insurance companies updating the
information and submitting the new W-9 form. I have to type up a letter
stating the date the center opened (but all of the insurance companies
have told me that they do not retro pay claims), the physician NPI's,
etc. We also have a new physician starting next week and I have been
submitting his information as well and any time there is a new
physician starting, it is now my responsibilty to make sure that they
are in network providers with the insurance companies. How do I
professionaly word this on my resume.

Any suggestions would be greatly appreciated.

Thanks in advance,
Nikky, CPC, CPC-P