# Question about job descriptions..........



## msbrowning (Apr 26, 2008)

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


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## FTessaBartels (Apr 28, 2008)

*Short and sweet*

I believe your resume should be relatively short. Bullets are better than full sentences. That said ...

For the first question how about:
*Monitor third-party payments daily; review, research and appeal denial of claims*.


For the second part I'd suggest:
*Responsible for credentialling physicians with insurance companies*.


If you have hard data on the results of your efforts, you might want to include that, as well ... for example ... on working denials - "recovered $100,000 in first 6 months."

Hope that helps.  And good luck!

As an aside ... it's my personal philosophy to ALWAYS have my resume up-to-date.  Three months after starting a new job, I update my CV.  And I look at it at least yearly to ensure that it really reflects my skills and training.  It's usefull for many applications, including community work. (I sit on several boards of non-profits, and they always want a CV.)

F Tessa Bartels, CPC


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## msbrowning (Apr 30, 2008)

Thank you so much for responding and for the advice. I normally keep my resume updated but I realized that these descriptions were not on there.


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