catherine ryan

Investigated members/claims for potential other accidents or other insurances and processing COB and TPL claims as well as filing statutory liens and negotiating lien settlements with attorneys. Responded to provider, member and internal company inquiries regarding all COB and TPL policies and procedures.

Supervised staff of 9 employees responsible for billing and posting payments for health center's medical, dental and social service visits. Developed and implemented departmental policies and procedures; created reduction plans for accounts receivables. Generated monthly billing reports for Board of Directors meetings.

Supervised staff of 12 employees responsible for processing and posting of cash receipts totaling $33 million, claim adjustments, mail processing and distribution and data entry. Oversaw the implementation and operations of the HMO Blue Billing Unit, responsible for the billing of HMO Blue's health center workers' compensation and auto related claims and reported billing activities to health center directors.

Supervised the analysis of subrogation, workers' compensation and coordination of benefits policies and procedures and the development and implementation of new policies for increased recoveries. Managed priority subrogation cases assigned by Director as well as negotiated with attorneys to settle high dollar liens.

Investigated third party liability and workers' compensation cases for the recovery of improperly paid monies and processed claim adjustments as well as filed and negotiated statutory liens. Responded to subscriber, provider and attorney inquiries regarding subrogation and workers' compensation policies.

Supervised all audit and recovery activities to ensure optimal savings, quality productivity, timely audits and accurate claims processing according to Plan requirements. Managed staff of 25. Ensured annual recovery goals were achieved, resulting in $36 million in savings. Oversaw the contracting of multiple external vendors and served as key contact with vendors to ensure that contractual obligations and deliverables were met. Ensured that Audit and OPL activities were conducted in accordance with Mass Health and provider contracts as well as industry standard billing guidelines. Negotiated audit discrepancies, resolved problematic claim issues and settled high dollar third party liability lien cases with hospitals, providers and attorneys.

Managed and coordinated the activities of staff to ensure that annual recovery goals for COB and TPL were achieved. Attained annual departmental recovery goals, averaging $5.5 million in savings. Designed and upgraded activity reports to maximize recoveries and increase identification of cases of third party accidents and dual insurance. Administered the quality control of all departmental functions; conducted in-service presentations to educate internal departments regarding COB and TPL policies and procedures.

Supervised the daily activities of the COB and TPL unit responsible for the recovery of $5.4 million in savings. Served as liaison with all internal departments and external sources for COB and TPL issues.

Managed the East region Provider Relations staff of 8 employees; serviced the needs of providers including hospitals, physician groups and individual practitioners. Managed provider network in East region ensuring compliance with Plan guidelines and provider satisfaction. Ensured regional staff complied with data integrity standards, credentialing requirements, provider hierarchy set ups and inquiry turnaround times.

Graduated Magna Cum Laude Activities and Societies: Work study program at BU School of Education