Richard Krasner, MA, MHA
7151 Summer Tree Drive
Boynton Beach, FL 33437
(561) 603-1685, cell
Detail-oriented, professional with extensive Insurance Claims Administration, Claims Financial Analysis and Information Systems/Technology experience seeking position in Healthcare Administration.
* Strong analytical and problem solving skills.
* Strong financial, organizational, written and verbal communications skills.
* Strong database management and quality assurance skills.
* Able to respond to complex questions from internal and external customers.
* Able to work independently; team player; self-motivated.
* MS Office and Windows
Master’s in Health Administration, Florida Atlantic University, Boca Raton, FL, Dec. 2011
Introduction to US Health Care Systems Organization Behavior in Healthcare
Health Care Mgmt. (elective)Topic: Healthcare Quality Health Law
Health Policy Healthcare Finance
Planning & Mktg. in Healthcare The 2010 Affordable Care Act (elective)
Research Methods for Healthcare Mgmt.
EnergySmart Hospitals: A Comparative Review
Banning Soda under the SNAP Program: A Policy Review
Legal Barriers to Implementing Int’l Providers into Medical Provider Networks for WC
PPACA: The End of Workers’ Compensation?
Medical Management Internship Paper
M.A., History, New York University, New York, New York
B.A., Liberal Arts, SUNY Brockport, Brockport, NY
Insurance Claims Administration:
* Processed, investigated and paid Workers’ Compensation, General Liability, Auto- No-Fault, & STD (Short-term disability, i.e. pregnancy) claims for both medical and indemnity issues.
* Reviewed claimant’s eligibility for continued medical and indemnity payments.
* Reviewed all medical records, reports and requests for payments to determine medical status and proper charges for services rendered.
* Consulted with claimant’s physicians and company medical consultants. Assigned, coordinated, and supervised all independent medical exams (IME’s). cost-containment reviews, rehab assignments and investigations with outside vendors.
* Familiar with WC and Medical Claims Coding (DRG’s, CPT. ICD-9, & Fee Schedules)
* Managed and improved overall administration of claims unit for retail insurance broker. Reduced errors and omissions by more than 50%.
* Coordinated processing of claims in a timely manner and within acceptable parameters.
* Interacted with client and company loss control/safety personnel to improve monitoring of claims and incidents.
* Developed and implemented claims coding format, procedures and data entry procedures for greater efficiency.
* Administered claims unit of small automobile carrier as part of new management team that made $2,000,000 for company in first three months of operation.
* Examined and interpreted insurance policies to determine extent of legal liability under terms of policies, endorsements and riders. * Analyzed legal and litigation documents such as Attorney’s Letters, Summons and Complaints, Demands for Judgment, Stipulations, Depositions and other pre-trial documentation.
* Processed request for claims payment checks/drafts. Expedited issuance of checks/drafts. Distributed checks/drafts to claimants or claimant’s representative.
Claims Financial Analysis:
* Performed and conducted detailed risk and loss analysis.
* Developed the analysis to determine the best levels of self-insurance and deductibles.
* Designed an effective strategy to reduce frequency and severity of claims.
* Reviewed, verified and tracked all payments. Saved company over $800,000 from vendor billings
* Prepared and maintained all filings and reports.
* Analyzed clients’ risk experience factors to determine changes to risk exposure.
* Created and generated loss analysis reports, improving risk analysis/exposure identification. Reduced errors and omissions by more than 50%.
* Investigated, analyzed and coordinated correction of data discrepancies, saving client over $100,000 in premium costs.
* Conducted periodic audits to review and analyze loss development.
* Established, analyzed and adjusted loss expense reserves. Reviewed and evaluated potential for recovery of all claims payments.
* Obtained and computed wages to determine indemnity payments.
* Prepared and calculated property loss inventories for proper adjustment of claims.
* Processed internal and external requests for data. Performed data gathering and risk analysis.
* Performed data integrity; data and system reconciliation; running of reports and monthly loss runs; coordinated and compiled loss data; month-end processing.
* Analyzed, researched, defined and implemented user business data reporting requirements and procedures.
* Reviewed computer system capabilities. Tested and analyzed data reporting software.
* Assisted in testing of database software during data conversion process.
* Documented data reporting requirements. Developed and executed test plans.
* Managed, redesigned, improved and fully-automated database application.
Transforming Workers’ Comp Blog, Boynton Beach, FL 2012 – Present
Risk Management Consulting Services, Boynton Beach, FL 2002 – 2010
Multiple consulting projects:
Strategic Outsourcing, Inc., Charlotte, NC
Environamics, Inc., Charlotte, NC
Fredrick C. Smith Clinic, Marion, OH
Bonitz, Inc., Charlotte, NC
Aon Risk Services of TX, Inc., Houston, TX 2001 – 2002
Sr. Specialist/Data Mgmt.
Consultant 1995 – 2001
Various assignments, Dallas, TX
Data Analyst, Stirling Cooke, Dallas, TX
BPO Compliance Analyst, PMSC, Sarasota, FL
Data Services Consultant, NCCI, Inc., Boca Raton, FL
Underwriting Data Analyst, Allstate, Boca Raton, FL
Hamond & Regine Inc., Claims Administrator, Mineola, NY
American Colonial Insurance Company, No-Fault Claims Supervisor, NY, NY
Greater New York Mutual Insurance Co., WC Claims Examiner, NY, NY