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Loretta Pinkowski

Expertise In: Chiropractic

Name : Loretta Pinkowski
Experience : 23
Specialty : Chiropractic
Location : Upland,CA
Description :

Loretta Pinkowski has 20+ years experience that demonstrates effective planning, coordinating and conducting the analysis of business processes; Training, administering and leading. She can multi-task and flexible in work environment and has excellent negotiation skills.

Skills:

  • She has spent 22 years mastering Healthcare Information Management
  • Can independently initiate
  • Identify and coordinate analysis of complex client needs
  • Interpretation of federal and state laws
  • Effective Negotiation skills
  • Strong oral & written communication skills. Skillful computer utilization
  • Strong organizational skills
  • Can apply innovative approaches to solutions
  • Ability to solve complex problems in creative & effective ways
  • Critical Thinking Process Skills - Business consulting and analysis
  • Strong understanding of Workers Compensation law
  • Litigation procedures in both WCAB & Small Claims Court
  • Familiar with mainframe, FilemakerPro, legacy systems, MS Office products
  • Knowledge of benefits & provider contracting

Experience:

  • Managing claim billing/ collections for client doctors in multiple facilities statewide-Worker’s Comp and PI specialist, Group Health insurance, Medicare.
  • File Liens, work with attorneys, and represent clients as Hearing Representative with strong litigation focus. Appear at court or Board proceedings & aggressively advocate the position of the company and/or the account.
  • Remain current on related legal & regulatory governances and changes
  • Exhibit and encouraging business integrity and credibility. Establish & maintain cooperative and effective relationships with a broad range of professional staff.
  • Processing medical claims from doctors, medical offices, and hospitals using CPT, ICD-9 / ICD-10 & HCPCS codes.
  • Consulted on the integration of application systems into the work environment, regarding operational and training implications.
  • Succinctly and clearly developed policies and procedures for Systems Administrators.
  • 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. Tracked, monitored and reported results of improved automated process systems
  • Demonstrated expertise in functional area business processes and understood assigned and cross functional areas.
  • Worked closely with IS in JAD sessions to develop automated Medi-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.

Achievements:

  • Handled Cardiology insurance billing and collections for a 45-doctor group. Collected $75,000 back payments from local IPA prior to their bankruptcy
  • Identified opportunities for increasing business efficiency through improved automated process systems
  • Associations:
  • Since 2010 Member American Academy of Professional Coders (AAPC)