Loretta Pinkowski

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)